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Medical Insurance Plans 

Medical insurance coverage plans, such as the Fee-for-Service Plans, Health Maintenance Organizations (HMOs), Point-of-Service Plans (POS) and Preferred Provider Organizations (PPOs) come in many forms, major and minor. Theu also have many different methods of billing patients and insurance companies! Making decisions to achieve optimal reimbursements should always best be handled by an experienced medical biller.  

Percentage of Health Insurance Coverage

Medical billers must understand all aspects of common health care and medical insurance options, including the different plans, carrier requirements, and state and federal regulations. It is also essential that they are able to find and pinpoint relevant information from source documents so that all claims for care and procedures are properly processed.

According to the U.S. Census Bureau there were 2.4 nurses working in the United States.

243.3 million
The number of people with health insurance coverage in 2003, an increase of 1.0 million from 2002. The percentage of the population with health insurance in 2003 was 84.4 percent, down from the 84.8 percent with coverage in 2002.

91.8%
The percentage of people with health insurance coverage in 2003 among people living in households with incomes of $75,000 or more. The likelihood of being covered by health insurance rises with income, as the corresponding rate for people with annual household incomes of less than $25,000 was 75.8 percent.

82.5%
The percentage of full-time workers age 18 to 64 covered by health insurance in 2003, higher than the rate for part-time workers (76.2 percent) or nonworkers (74.0 percent).

60.4% and 174.0 million
The percentage and number of people covered by employment-based health insurance in 2003, down from 61.3 percent and 175.3 million in 2002. This decline essentially explains the fall in total private health insurance coverage over the period, from 69.6 percent to 68.6 percent.

26.6% and 76.8 million
The percentage and number of people covered by government health insurance programs in 2003, up from 25.7 percent and 73.6 million in 2002.

Health Insurance Language

Examples

Allowable: The amount that is paid to the provider by the insurance is known as an allowable. For example, although a psychiatrist may charge $80.00 for a medication management session, the insurance may only allow $50.00, so a $30 reduction would be assessed.

Copayment: The insurance payment is further reduced if the patient has a copay, deductible, or a coinsurance. If the patient in the previous example had a $5.00 copay, the doctor would be paid $45 by the insurance. The doctor is then responsible for collecting the out-of-pocket copay from the patient.

Deductible: If the patient had a $500.00 deductible, the patient would have to pay the contracted rate of $50 ten times until the deductible was met, at which point the insurance would begin to cover a portion of the charge.

Coinsurance: A coinsurance is a percentage of the allowed amount that the patient must pay. It is most often applied to surgical and/or diagnostic procedures. Using the above example, a coinsurance of 20% would have the patient owing $10 and the insurance company owing $40.

(Examples in the above paragraph are provided under the terms of the GNU Free Documentation License.)

Acronyms

An acronym is a term formed from the initial letter or letters of each of the major parts of a compound term. This list explains acronyms found on the cms.hhs.gov web site and other acronyms that are commonly used: Acronyms A-Z.