Discover how hospital alliances work in health insurance, enabling multiple hospitals to share services and reduce costs, helping them stay competitive in the healthcare market.
Learn about the role of a Designated Mental Health Provider in health insurance policies and how they deliver mental health services through medical plans.
Learn about Group Model HMO, a type of Health Maintenance Organization that negotiates rates with specific provider groups and hospitals to offer medical care to policyholders.
Learn about the physician contingency reserve in health insurance, a fund composed from claim deductions aimed at motivating appropriate healthcare provision.
Learn about the role of a Primary Care Physician (PCP) in health insurance, how they provide primary medical care, and when they refer you to specialists.
Explore the concept of prospective reimbursement in health insurance where providers receive annual payments based on previously established rates. Learn how this system impacts healthcare providers and patients.
Learn about Quality Assurance in health insurance, the essential process of reviewing and enhancing the quality of health services and coverage. Discover its importance and methodologies.
Discover how Diagnosis Related Groups (DRGs) are used to determine compensation for medical providers in the health insurance industry.
Explore the concept of utilization in health insurance, defined as the amount of use a health plan receives from a specific group of policyholders. Learn how it's measured and its impact on policy costs.
Discover how managed care health insurance plans work, their benefits, and the methods they use to manage healthcare expenses for employers and employees.
