lESSON 9 ASSIGNMENT INSURANCE TERMS Download (double click the link) and complete theworksheet using the number of the appropriate term to complete each statement. Or, you may copy and paste the...

Download (double click the link) and complete theworksheetusing the number of the appropriate term to complete each statement. Or, you may copy and paste the assignment shown below into a word document to complete. After saving your answers, upload the completed document.

Understanding Insurance Terms:

Part 1: Use the reading assignment for this week and the government websitehttps://www.healthcare.gov/glossary/(Links to an external site.)as references in completing this assignment. Use the terms in the list to select the best term to complete the statement. Place the number of the term in the space provided to the left of the statement. One term is used twice. The first one is completed as an example. (1 point each.)

1. Claim
2. Coinsurance
3. Copayment
4. Deductible
5. Diagnostic Test
6. Durable Medical Equipment (DME)
7. Emergency Room Care / Emergency Services
8. Excluded Services
9. Formulary
10. Home Health Care
11. Maximum Out-of-Pocket Limit
12. Medically Necessary
13. Network Provider (Preferred Provider)
14. Out-of-network Provider (Non-Preferred Provider)
15. Outpatient
16. Plan
17. Preauthorization
18. Premium
19. Prescription Drug Coverage
20. Preventive Care
21. Primary Care Physician
22. Referral
23. Skilled Nursing Care
24. Urgent Care
25. Inpatient

1. _16__ Jane has a health insurance ________ that pays for some of her health care costs.
2. ___ She pays a monthly ______________ for her coverage
3. ___ Her card states that Dr. Jones is her PCP this stand for _______________.
4. ___ Her card states that she must pay a $20_________ at each visit to her PCP.
5. ___but $50 if she sees a specialist if they are a preferred or ________provider.
6. ___ In order to see a specialist, Jane’s insurance requires that her PCP issue a _________.
7. ___ If these doctors are non-preferred providers or _________ providers, then she must pay double the amounts listed in #2.
8. ___ Janes insurance plan requires Jane to pay a $100 _________ each year before it starts to cover any medical expenses.
9. ___ After this $100 has been paid, then jane must pay 20% of each medical bill which represents the ___________until a total of $2500 has been paid.
10. ___ Once Jane has paid a total of $2500 for medical expenses, she will no longer have to pay any more of the costs herself because her ________________has been reached.
11. ___ Jane needs to have a colonoscopy, and this does not require a hospital stay, it is an example of an _________________procedure.
12. ___ Her insurance covers its cost because it is considered _____________.
13. ___ Her husband is having a total knee replacement and must stay in the hospital for three days afterward; this is an _________procedure.
14. ___ Jane would like to get a rhytidectomy (facelift), but this is considered cosmetic surgery and is a/an _________with her insurance plan.
15. ___ Before having his knee replaced, the physician’s office had to submit documentation to show _____________ before approving coverage for the surgery.
16. ___ Before the surgery, Jane’s husband had to an EKG. The EKG is an example of a___________.
17. ___ This is an example of a _______________.
18. ___ Jane’s husband required a wheelchair after his knee surgery, and this was covered under his Medicare Part B plan. Part B covers __________________equipment.
19. ___ A physical therapist will be making periodic visits along with a Registered Nurse while Jane’s husband is recovering from his surgery at home. This is paid by the insurance plan because it includes ______________ coverage.
20. ___ If Jane was not able to care for her husband at home after surgery, he would have needed temporary care at a ______________
21. ____ A preauthorization may be required for a medical service, or there could be a rejection of the insurance_________.
22. ___ Before Jane’s colonoscopy, she must use a preparation indicated for bowel cleansing prior to the colonoscopy. This solution requires a prescription, but jane only pays a copay of $10 because her insurance includes _____________________as an essential element of coverage.
23. ___ The insurance plan does limit what preparation can be used to those that are on its drug __________.
24. ___ The physician submitted an insurance _________ with the specified information to bill for the procedure.
25. ___ If Jane as a serious health problem, she should seek healthcare services from an______________
26. __ but minor issues can be taken care of at an _________ facility which is less costly.

Part 2 (5 Points each)

(A) Write a short essay (50-words or more) that explains the concept of the PCMH and the role of the medical assistant in this health care delivery model. (If your major is PHN, RN or another role you may answer the question from that point-of-view). Cite and list any references used in this essay. Showcase your writing skills with clear wording and correct spelling and punctuation.

(B) Write a short essay (50-words or more) that explains the difference between the terms managed care, referral, prior authorization, and precertification regarding insurance plan requirements with an example provided for each. Cite and list any references used in this essay. Showcase your writing skills with clear wording and correct spelling and punctuation.

(C) Explain the concept of coordination of benefits (COB) and provide an example. Cite and list any references used in this essay. Showcase your writing skills with clear wording and correct spelling and punctuation.