Exam (elaborations)
OT 502 Final Exam (1).
OT 502 Final Exam (1).
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OT 502 Final Exampayment for medical or health care services and an essential component of the continued
existence of any health care organization - ANS-reimbursement
federal and state funded program for indivdiuals with low income, pregnant woman, people with
disabilities, and those who need long term care - ANS-medicaid
who is medicaid for? - ANS-low income, pregnant women, people with disabilities, ppl who need
long term care
for individuals age 65 and older, younger than 65 with specific diagnoses, and/or in end stage
renal disease - ANS-medicare
federal and state funded program for children whose families do not qualify for medicaid
services but require healthcare reimbursement assistance. established by the balanced budget
act of 1997 - ANS-CHIP
aka commercial plans. purchased by employers or indivdiuals and is affected by federal
subsidies and policy - ANS-private health insurance
insurance coverage for active duty personel, retiree, and personnel of the civilian helath and
medical program of the department of veteran affairs and the veterans health program -
ANS-TRICARE
most common type of health insurance - ANS-private health insurance
represents health care delivery systems that began with implementation of the Health
Maintenance Organization Act of 1973, was intended to improve quality and accessibility as well
as streamline care, thereby controlling costs - ANS-managed care
4 types of managed care insurance plans - ANS-exclusive provider organizations, health
maintenance organizations, preferred provider organizations, point of service plans
require that indivdiuals only see specific health care professionals in a specified network to
receive coverage - ANS-exclusive provider organizations
indivdiual is assigned to a PCP who is responsible for care coordination (client needs referral to
access other services) - ANS-HMOs
have lower copays and health care services are reimbursed at a higher rate if they remain
inside the predetermined network as opposed to seeking care outside of network - ANS-PPOs
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