Understanding Healthcare & Managed Care Terms
We realize that some of the words and phrases used in healthcare can be confusing. Therefore, we have provided a quick reference guide for your use.
The insurance company pays physicians or medical groups a certain amount each month for each patient.
The fixed amount of money the insured person pays each time he or she sees a doctor, gets a prescription, or has a medical service rendered. Co-payments are typical of HMO plans.
The percentage of the total fee the insured person pays each time he or she sees a doctor, gets a prescription, or has a medical service rendered. Co-insurance is typical of fee-for-service plans such as PPOs.
A term to describe the process of signing up with a managed care health plan.
Paying for medical services when they are provided or when a bill is received. Payment can be in cash or as an insurance reimbursement.
HMO (Health Maintenance Organization) Plan
A benefit plan in which you must choose a primary care physician. This physician must be signed up with that group and HMO for any care or the HMO will not pay for the care.
Independent Physician Association (IPA)
An organization in which private-practice physicians agree to work together to negotiate with insurance companies; however, each of these physicians run their own office.