This subjective process is called __________. A(n) ____ rider allows you to stop paying premiums and keep your coverage in force if you become disabled. Older people (over age 65) are more likely to have __________ diseases.​, Which of these is an example of a chronic disease?​. B) a PPO allows the individual to use any service provider, while a POS plan requires the individual to … A(n) ____ is a group health insurance plan offering prepaid medical care to its members. The __________ is equal to the number of deaths of infants under 1 year of age per 1,000 live births in a given year. The enrollees may go outside the network, but would incur larger costs in the form of higher deductibles, higher coinsurance rates, or non- Preferred Provider Organization IC 27-8-11-5 State law requires that each person organizing a preferred provider plan must file with the Commissioner before March 1 of each year a statement, under oath, with information regarding the preferred provider plan. What is the world's leading infectious killer?​. health insurance quiz quizlet › Verified ____ is an amount available to borrow or at cancellation when you own a permanent life insurance policy. All of these were components of Flexner's model medical school except __________. Mobile. Consequently, sickness is viewed as a form of deviant behavior that must be controlled by society. PPO providers are paid a "modified" fee for service basis (a) They agree to provide services at a discount from "full charge" (b) They agree to not "balance bill" the patient e.g. AlaMed is a Workers' Compensation Preferred Provider Organization formed in 1991, by five Alabama Third Party Administrators in order to minimize the spiraling workers' compensation medical cost. What is a characteristic of preferred provider organizations? A traditional type of insurance in which the health plan will either pay the medical provider directly or reimburse you after you have filed an insurance claim for each covered medical expense. Flexibility to visit or choose doctors and hospitals outside network. With a(n) ____ clause, insurance cannot be cancelled during a specified period of time. Health Maintenance Organization. When seeing a specialist a referral is usually needed unless the patient has a PPO insurance or they are covered by Medicaid. 1. Just like an HMO, or health maintenance organization, a PPO plan offers a network of healthcare providers you can use for your medical care. Someone smoking cigarettes is an example of __________ drug use.​. Conflict theorists use the term __________ for the system of local physicians and hospitals as well as global health-related industries such as insurance companies and pharmaceutical and medical supply companies. A PPO Plan isn't the same as Original Medicare or a Medicare Supplement Insurance (Medigap) policy. Of these the most common include preferred provider organization (PPO), health maintenance organization (HMO), and Tricare, which is a form of military health insurance. This Act covers injuries that result in whole or in part from the employee's work. A preferred provider organization (PPO) is a network of doctors and hospitalswho form a corporation to provide medical services to self-insured businesses or for health insurance companies. ​have no incentive to limit doctor or hospital visits, In regard to a third-party provider system of health care, patients________________.​. A preferred provider organization (PPO) is a medical care plan in which health professionals and facilities provide services to subscribed clients at … Discuss preferred provider organization plans (PPO) plans. __________ refers to a health care system in which the government owns the health care facilities and employs the physicians. The Preferred Provider Organization would cover the cost. Medicare Advantage Regional Preferred Provider Organizations (RPPOs) ... completed form needs to be faxed to Yvonne Rice at (410) 786-0322. a.) Providers … A network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards. There is a subjective component to how some conditions such as childhood obesity, drug addiction, and alcoholism have come to be considered as diseases. In Great Britain, the government sets health care policies, raises funds and controls the medical care budget, owns health care facilities, and directly employs physicians and other health care personnel. But unlike PPO plans, care under an HMO plan is covered only if you see a provider within that HMO’s network. ... Quizlet Live. Health Insurance Flashcards | Quizlet. A PPO plan is one that allows free movement both within and outside of the plan's participating provider network. Sociologists use the term __________ for socially defined and culturally variable states of interference with health.​, Social epidemiologists investigate_______________.​, Social epidemiologists use the term __________ for biological, nutritional, chemical, and physical factors that cause disease.​, obesity will reduce life expectancy by two to five years. the majority of people have through their employers. They do offer incentives to help get members to use providers that are part of a provider panel. The initials, PPO, refer to the provider network type and the care management system. Preferred Provider Organization (PPO) A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. A preferred provider organization is a collection of health care providers such as physicians, hospitals, and clinics who offer their services to certain groups at prearranged discount prices. The PPO has doctors, hospitals, and health care providers that are part of its network that are available to provide your medical needs. Diagrams. What are the main advantages and disadvantages? To predict the likelihood of death occurring, insurance companies use ____ table. Preferred Provider Organization. Preferred provider organization The name a company assigns to a commercial drug product for marketing and identification purposes is called the _____________ name. In 2011, the Illinois Workers' Compensation Actwas reformed to give employees access to Preferred Providers for their medical treatment. In a __________, patients pay premiums into a fund that in turn pays doctors and hospitals for each treatment that patient receives.​, __________ provide, for a set monthly fee, total care with an emphasis on prevention to avoid costly treatment later.​. The __________ theory emphasizes the political, economic, and social forces that affect health and the health care delivery system. Advantages: allows plan members to visit any doctor or hospital without referrals from a PCP. These providers have agreed to provide care to the plan members at … It usually offers extra Benefits [Glossary] than Original Medicare, but you may have to pay extra for these benefits. PPOs encourage you to But … The name of the bill is the __________. A ____ is a small insurance policy that modifies the coverage of the main policy. These providers have contracts that usually provide discounts. You pay less if you use providers that belong to the plan’s network. According to the __________ approach, if society is to operate as a stable system, it is important for people to be healthy and to contribute to their society. Two of the most common sources of chronic disease and premature death are __________.​, Taking an aspirin to reduce a fever is an example of __________ drug use.​, ​any substance other than food and water that, when taken into the body, alters its function in some way, __________ is the term for an institutional system concerned with the scientific diagnosis, treatment, and prevention of illness.​, medical colleges should provide the best medical care. __________ is an approach to health care that focuses on prevention of illness and disease and is aimed at treating the whole person—body and mind—rather than just the part or parts in which symptoms occur. A(n) ____ is a group health care providers who band together to provide health services for set fees. The three types of insurance (medical, hospital, and surgical) are called ____. ____ life insurance is protection for a specified period of time. In return, the group refers its members to the preferred providers for health care services. A Preferred Provider Organization (PPO), is a type of Medicare Advantage plan available in a local or regional area in which you pay less if you use doctors, hospitals, and providers that belong to the network.You can use doctors, hospitals, and providers outside of the network for an additional cost. Health Details: Which of the following health insurance plans offers the most comprehensive coverage?PPO Every month, the individual pays a $50 _____ to an insurance company to have health insurance plan. ____ insurance provides protection from financial loss that might otherwise occur when a person dies. PPO stands for preferred provider organization. The most commonly reported sexually transmitted disease, in terms of number of cases, listed by the Centers for Disease Control and Prevention is __________.​. ♦ Preferred provider organization (PPO) plan - An indemnity plan where coverage is provided to participants through a network of selected health care providers (such as hospitals and physicians). providers may have the opportunity to participate in a preferred provider network is to form their own PPO that then is offered to payers. Canada has a(n) __________ system in which all citizens receive medical services paid for by tax revenues. The differences, besides acronyms, are distinct. Which of the following reasons was not cited as a reason why neighborhoods make a difference in relation to health and mortality? __________ theorists are most likely to be concerned with unequal access to health care, power relationships in the health care system, and the role of profit in maintaining human health. preferred provider organization(PPO) A plan under which specified health services are rendered by participation physicians to an enrolled group of persons, with fixed periodic payments made in advance, by or on behalf of each person or family. d. they provide less options for patients. Because certain providers are “preferred,” you can save money by using them. ____ term insurance gives the policyholder the right to renew each year, without having to pass a physical exam. Researchers predict that over the next few decades in the United States, ________________. However, today the World Health Organization (WHO) defines health as the __________.​, __________ is any system of cost containment that closely monitors and controls health care providers' decisions about medical procedures, diagnostic tests, and other services that should be provided to patients.​, AIDS is caused by __________ and is among the most significant health problems that this nation and the world face today.​. ____ riders give a policyholder the right to buy a new policy or additional coverage without evidence of good health. WHEREAS, USA is a Preferred Provider Organization (PPO) engaged in the business of administrating quality health care services at an affordable price through its products {USA H & W Network, a group health and wellness program, USA Workers’ Injury Network (USA WIN), and USA Medicare (USA Senior Care)}, and Provider b. they provide more physician options for patients. When Illi… ​__________ use occurs when a person takes a drug for no purpose other than for achieving a pleasurable feeling or an altered psychological state. This approach may be more expensive … A preferred provider organization is a form of __________ . There are few opportunities to see a non-network provider. c. they provide cheaper care than the health maintenance organizations. Preferred Provider Organization (PPO) plans are health care plans contracted with a network of medical providers. In accordance with Subpart 325-8 of Title 12 NYCRR, all insurance carriers who have contracted with a preferred provider organization (PPO) for the treatment of workers' compensation injuries and illnesses shall report to the Chair pertinent information related to insured employers who have elected to utilize the preferred provider organization. Throughout its history in the United States, payment for medical care has been __________.​. __________ is the most extensively used illegal drug in the United States.​, Which of these is the single most preventable cause of disease, disability, and death in the United States?​. A(n) ____ is a group health insurance plan offering prepaid medical care to its members. This is an example of a __________. ____ insurance is a plan for sharing the risk of financial loss resulting from an accident or illness. A health maintenance organization (HMO) is a type of managed healthcare system. People who will inherit money at the death of the insured are called ____. Preferred Provider Organization – PPO: A preferred provider organization (PPO) is a type of health insurance arrangement that allows plan participants relative freedom to … Homosexuality has been removed from the list of mental disorders compiled by the American Psychiatric Association. A type of permanent insurance, ____ has a premium and a death benefit that are not fixed. According to many __________ theorists, problems in U.S. health care delivery are rooted in the capitalist economy, which views medicine as a commodity that is produced and sold by the medical-industrial complex. In large part, formation of provider networks is motivated by the fear that the networks created by third-party payers will not include many providers. If the applicant is a line of business versus a legal entity, does the Board of Directors of the corporation Which of the following is used to treat syphilis? A(n) ____ is a group health care providers who band together to provide health services for set fees. trade When benefits from more than one health plan are limited to 100 percent of medical costs, this is called ____. Researchers have identified several reasons why neighborhoods make a difference in relation to health and mortality. When you need medical attention, you visit the doctor or hospital of your choice. A form of managed care; The insurance company has negotiated discounts for services provided[ CITATION Har134 \l 1033 ]. . __________ is a measure of the estimated average lifetime of people born in a specific year.​, ​state of complete physical, mental, and social well-being, At one time, health was considered to be simply the absence of disease. Quizlet Learn. An HMO is a Health Maintenance Organization, while PPO stands for Preferred Provider Organization. PPO members have the option to select one of these preferred providers and only pay their deductible and office visit copay, or select an out-of-network provider and pay a slightly higher amount. on a fee-for-service basis Throughout its history in the United States, payment for medical care has been __________. Final 2008 MA Regional PPO Application, 1-31-2007 7 of 75 III. Sign up. You can use doctors, hospitals, and providers outside of the network for an additional cost. Help. Select one: a. they reimburse after the patient pays for healthcare services. Preferred Provider Organizations: They are a hybrid of HMO's they do not mandate that beneficiaries use specific providers. A. Additionally, in the state of Illinois an employee is covered under this Act from the moment they start their job. A __________ is a document stating a person's wishes regarding the medical circumstances under which his or her life should be terminated. With a(n) ____ policy, premiums are paid throughout the life of the insured. PPO (Preferred Provider Organization): A PPO Plan model is one of three most often discussed healthcare delivery systems. 2. c)Exclusive Provider Organization (EPO): This is an health insurance plan that people who choose this plan or employees in an organization can make use of any health care provider or medical facilities in this organization. After a lengthy political battle, a health care reform bill was signed into law in the United States in 2010. This is an example of __________.​. HMOs, and their close cousins, preferred provider organizations (PPOs), share the goal of reducing healthcare costs by focusing on preventative care and implementing utilization management controls. POLICYMAKING BODY - 422.503 A. From the conflict perspective, which of these groups benefits the least from the current U.S. health care system? A preferred provider organization is a form of _____ . Flashcards. In health insurance in the United States, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the top insurer's or administrator's clients. According to the text, with professionalization, __________ gained control over the entire medical establishment in the United States.​, __________ is the term for any activity intended to improve health.​, __________ is the study of the causes and distribution of health, disease, and impairment throughout a population.​. In the state of Illinois, The Workers' Compensation Act provides that accidents that arise out of and in the course of employment are eligible to receive workers' compensation benefits. __________ means that patients are billed separately for each service that they receive, including treatment by doctors, laboratory work, hospital visits, prescriptions, and other health-related expenses.​. The most common type of health insurance is a(n) ____. 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