Saturday, March 17, 2012

Types of Insurance

There are three basic types of medical insurance plans. They are Managed Care Plans, Indemnity plans and Combination Plans.  The three plans are very different in method and focus, here’s how:

Managed Care Plans
Indemnity Plans
Combined Plans
Focus on preventative care
Focus on present illness
Any combination of the managed care and Indemnity plans as written by the insurance carrier
Strict authorization/referral guidelines
Fewer requirements for service authorizations. No referrals

Limited list of physicians covered in network
Larger list of network physicians. Policies sometimes have out of network benefit coverage

No deductible
Has deductible

No coinsurance
Has co-insurance

Small out of pocket costs for the patient in the form of co-payments
Larger out of pocket expense with deductibles and coinsurances. No co-payments

More rules less expense
More expense less rules
Depends on the plan and benefits

In some situations patient's who have been injured will be covered by a “liability carrier”. This may be the auto insurance or workman’s compensation carrier.

Liability insurance does not have traditional insurance card. The information will be provided by the patient initially. The patient should give you the name and contact number for an insurance representative called the “adjustor” in addition to their id number called by the liability carrier the “claim number”. The adjustor reviews the accident details and handles the medical claim payment. When you speak to the adjustor for the first time to confirm coverage be sure to obtain the following information:

A.                The “claim number”. This number is in place of a medical insurance policy number. The liability carrier will refer to the accident and injury as a “claim”, don’t get confused.
B.                 The accident date. This information will be required on the claim form for an accident.
C.                 Documentation requirements. It is a pretty safe bet that the liability carrier will want documentation or doctor’s notes with every medical bill.
D.                Their fax number. This will help when you have to send documentation or forms and sometimes they will allow claim submission via fax too. 


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