Healthcare Insurance Services

Written by Kimberly Clark
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A healthcare plan or healthcare insurance service is a company or organization that agrees to pay for all or a part of its members' medical care. In the healthcare industry, these entities are referred to as payers. The payer could either be a subsidy of a government program or part of the extensive commercial healthcare insurance sector.

Various Healthcare Insurance Services

Medicare and CHAMPUS (Civilian Health and Medical Programs of the Uniformed Services) are examples of federal government payers and there are strict guidelines on who qualifies to receive medical services under their provisions. To qualify for Medicare, a person has to be at least 65 years old, and receiving retirement or disability benefits from Social Security. CHAMPUS health benefits are reserved for military personnel, those active and retired, and their eligible dependents. Medicaid is another government payer. The federal government funds this program as well, but it is independently managed by each state. It was create in an effort to provide medical services to low-income families.

To participate in one of the commercial healthcare insurance services usually requires a monthly premium to be paid to the carrier. In addition, depending on the coverage level selected, a plan participant might be required to reach an annual deductible before any payments kicks in. However, there are generally no deductibles for those enrolled in plans operated by health maintenance organizations (HMO), but members usually have to pay a co-payment at the time of service.

Hospitals need to verify patient eligibility with their insurance services as soon as possible. With the most advanced software programs, verification can occur before any services are even performed. This can prevent both patients and hospitals from footing the bill for improperly filed insurance claims.

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