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Wk 3 Discussion Different Types of Insurance

Overview of insurance types like Medicare, Medicaid, Tricare, and Medigap, their pros and cons, and why eligibility knowledge is crucial for accurate medical coding and billing.

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    n What are the pros and cons of payment incentive programs, coverage, and eligibility requirements □ Why is it important to understand the eligibility requirements of various insurance types as a medical coder or biller? □ How does a medical coder or biller determine if a patient is eligible? What happens if they are not? Medicare ranges from specialty providers for the disabled. Medicare requirements is usually for people of the age 65 or older with the acceptance of people with end stage diseases such as renal disease, and cancer for example. The cons are policy holders can be responsible for deductibles and copays, need a referral to see a specialist, and are limited choices of providers who are in-network. The pros are preexisting medical diagnoses will not be denied in claims, no monthly premium payment. The requirements for Medicaid are very simple be deemed medically needy and below a certain tax bracket. They also provide medical coverage for pregnant women and children whose parents need insurance for a child, the elderly must be an United States citizens. The pros are no monthly premiums and affordable health care with little to no out-of-pocket cost. The cons are the limits of coverage and the limit of providers in the network. The requirement for Medigap is to be the age of 65 years of age and have Medicare Part B. The pros are some or all medical fees paid for and hospital coverage. The cons are the monthly premiums can differentiate and may be high, and not all plans cover Part B deductible. Tricare requirements is to be a soldier or a family member of one, be a sole survivor of one, and or ex spouse. The pros are comprehensive coverage for health, dental, and prescription, having discounted share cost . The cons are out of pocket costs, copayments, and varied paperwork, requirements are to be a spouse and child of a vet, be a servicer spouse or child of a vet that died in service or from a disability from service. The pros can be matched with a Medicare advantage plan. The cons are it does not cover dental. It is important to understand the insurance requirements so the patient can get the services they need in a timely manner, as well as understand the financial responsibility prior to service. The final understanding is to make sure their meet their copay and yearly deductible, so the health facility and the patient does not get penalized. A medical coder and biller can determine eligibility by reading the patient's plan as well as looking up the covered service codes.

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