Medical Billing and Coding

PPO (Preferred Provider Organization)

A combination of traditional fee-for-service and an HMO. When use the doctors and hospitals that are part of the PPO, you can have a larger part of your medical bills covered. can use other doctors, but at a high expensive. 

Maximum Out-of-Pocket Expenses

The most money you will be required pay a year for deductibles and coinsurance. It is fixed by the insurance company, in addition with  regular premiums. 

 

Managed Care

It is to manage costs, use, and quality of the health care system. All HMOs and PPOs, and many fee-for-service plans, have managed care. 

 

HMO (Health Maintenance Organization)

It is prepaid health plans. You needs to pay a monthly premium and it covers your doctors' visits, hospital stays, emergency care, surgery, checkups, lab tests, x-rays, and therapy. You should use the doctors and hospitals designated by the HMO plan

Deductible

The premium amount must pay each year by patient to cover the medical care expenses before insurance policy starts effective. 

 

Copayment

It is another way of sharing medical costs by patient. Patient needs to pay a flat fee to doctor for every time they receive a medical service(for example, $10 for every visit to the doctor). It is fixed by Insurance company

 

Coinsurance

The amount you are required to pay for medical care in a fee-for-service plan after you have met your deductible. The coinsurance rate is usually expressed as a percentage. For example, if the insurance company pays 80 percent of the claim, you pay 20 percent.