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Preferred Provider Organization
In U.S. health insurance, 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 insurer's or administrator's clients. Overview A preferred provider organization is a subscription-based medical care arrangement. A membership allows a substantial discount below the regularly charged rates of the designated professionals partnered with the organization. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network, unlike the usual insurance with premiums and corresponding payments paid either in full or partially by the insurance provider to the medical doctor. They negotiate with providers to set fee schedules and handle di ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Health Insurance In The United States
Health insurance in the United States is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage. In addition to medical expense insurance, "health insurance" may also refer to insurance covering disability or ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Exclusive Provider Organization
In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization. Doctors are paid as a function of care provided, as opposed to a health maintenance organization (HMO). Also, the payment scheme is usually fee for service, in contrast to HMOs in which the healthcare provider is paid by capitation and receives a monthly fee, regardless of whether the patient is seen. History Exclusive provider plans existed as early as 1983 as a variation of preferred provider plans, which emerged in the early 1980s. See also * Patient Protection and Affordable Care Act * Preferred provider organization In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Silent PPO
A Silent PPO is an organization that accesses a discounted rate for services from a physician, hospital or other health care provider without direct authorization from the provider to do so. Function Generally, insuring entities may negotiate contracts with the healthcare provider, with a defined set of reimbursement values for the work performed by the provider. These rates may entail a significant discount from the amount the provider would charge an uninsured patient. For a given provider, the amount of discount varies between different insuring entities, and a separate contract is negotiated with each entity. Silent PPOs create agreements with insuring entities, allowing buyers into the Silent PPO to access the terms of the lowest discounted rate available. Patients (and other insuring entities who are members of the Silent PPO) may then access the lowest discounted rate of the healthcare provider, even though the patient is not directly a member of the plan contracted ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Point Of Service Plan
A point of service plan is a type of managed care health insurance plan in the United States. It combines characteristics of the health maintenance organization (HMO) and the preferred provider organization (PPO). The POS is based on a managed care foundation—lower medical costs in exchange for more limited choice. But POS health insurance does differ from other managed care plans. Enrollees in a POS plan are required to choose a primary care physician (PCP) from within the health care network; this PCP becomes their "point of service". The PCP may make referrals outside the network, but with lesser compensation offered by the patient's health insurance company. For medical visits within the health care network, paperwork is usually completed for the patient. If the patient chooses to go outside the network, it is the patient's responsibility to fill out forms, send bills in for payment, and keep an accurate account of health care receipts. References Glossary Federal Employe ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Independent Practice Association
In the United States, an independent practice association (IPA) is an association of independent physicians, or other organizations that contracts with independent care delivery organizations, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis.Margaret E. Lynch, Editor, "Health Insurance Terminology," Health Insurance Association of America, 1992, Peter R. Kongstvedt, "The Managed Health Care Handbook," Fourth Edition, Aspen Publishers, Inc., 2001 Operation An HMO or other managed care plan can contract with an IPA, which in turn contracts with independent care providers or physicians to treat members at discounted fees or on a capitation basis. The typical IPA encompasses all specialties, but an IPA can be solely for primary care, could be single specialty, or could be a set of other care providers such as psychologists or even providers of social services such as food pantries, homele ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Health Maintenance Organization
In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis. The Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options if the employer offers traditional healthcare options. Unlike traditional indemnity insurance, an HMO covers care rendered by those doctors and other professionals who have agreed by contract to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers. HMOs cover emergency care regardless of the health care provider's contracted status. Operation HMOs often require members to select a primary care ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Dental Plan
Dental insurance is a form of health insurance designed to pay a portion of the costs associated with dental care. There are several different types of individual, family, or group dental insurance plans grouped into three primary categories: Indemnity, Preferred Provider Network (PPO), and Dental Health Managed Organizations (DHMO). Generally dental offices have a fee schedule, or a list of prices for the dental services or procedures they offer. Dental insurance companies have similar fee schedules which is generally based on Usual and Customary dental services, an average of fees in an area. The fee schedule is commonly used as the transactional instrument between the insurance company, dental office and/or dentist, and the consumer. Types of coverage Indemnity Dental Insurance Plan With indemnity dental plans, the insurance company generally pays the dentist a percentage of the cost of services. Restrictions may include the co-payment requirements, waiting period, stat ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Patient Protection And Affordable Care Act
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965. The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered. The law also enacted a host of delivery system reforms intended to constrain healthcare costs and improve quality. After it went into effect, increases in overall healthcare spending slowed, including premiums for employer-based insurance plans. The increased coverage was ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Western United States
The Western United States (also called the American West, the Far West, and the West) is the region comprising the westernmost states of the United States. As American settlement in the U.S. expanded westward, the meaning of the term ''the West'' changed. Before about 1800, the crest of the Appalachian Mountains was seen as the western frontier. The frontier moved westward and eventually the lands west of the Mississippi River were considered the West. The U.S. Census Bureau's definition of the 13 westernmost states includes the Rocky Mountains and the Great Basin to the Pacific Coast, and the mid-Pacific islands state, Hawaii. To the east of the Western United States is the Midwestern United States and the Southern United States, with Canada to the north, and Mexico to the south. The West contains several major biomes, including arid and semi-arid plateaus and plains, particularly in the American Southwest; forested mountains, including three major ranges, the ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Managed Care
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("managed care techniques"). It has become the predominant system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010. ...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The p ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Taft–Hartley Act
The Labor Management Relations Act of 1947, better known as the Taft–Hartley Act, is a Law of the United States, United States federal law that restricts the activities and power of trade union, labor unions. It was enacted by the 80th United States Congress over the veto of President Harry S. Truman, becoming law on June 23, 1947. Taft–Hartley was introduced in the aftermath of a Strike wave of 1945–46, major strike wave in 1945 and 1946. Though it was enacted by the Republican Party (United States), Republican-controlled 80th Congress, the law received significant support from congressional Democratic Party (United States), Democrats, many of whom joined with their Republican colleagues in voting to override Truman's veto. The act continued to generate opposition after Truman left office, but it remains in effect. The Taft–Hartley Act amended the 1935 National Labor Relations Act (NLRA), prohibiting unions from engaging in several unfair labor practices. Among the pract ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
The Segal Group
Segal (formerly Segal Rogercasey prior to 2017) is a benefits and human resources consulting firm headquartered in New York City, with more than 1,000 employees throughout the U.S. and Canada. It is the parent of Segal Marco Advisors and Segal Benz. History The firm was known as Segal Rogerscasey prior to its acquisition of the Marco Consulting Group in 2017. Services Segal is privately held and employee owned, providing employee benefits and human resources related consulting services for multiemployer benefit funds, public sector organizations and the private sector. Segal offers services in actuarial consulting, retirement benefits, health and group health benefits, compliance, communications, HR administration and technology, insurance brokerage related to HR and benefit plans (such as fiduciary liability, cyber liability, employment practice liability insurance and fidelity bonds), human capital, executive and employee compensation and rewards, organization effectivenes ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
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