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People from US normally acquire their medical insurance through their employer. An employer /company signs up for a particular health insurance plan, offers the plan to its employee and allows the employee to decide whether he/she wants to sign up. (Most employees do sign up and its often one of the firs

The role, structure and functions

How medical Insurance works

Types of medical insurance

 

WHAT IS MEDICAL BILLING?

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  • WHAT IS MEDICAL CODING?

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  • MEDICAL BILLING CLASSES

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MEDICAL BILLING FUNCTION

People from US normally acquire their medical insurance through their employer. An employer /company signs up for a particular health insurance plan..

 

 

 

 

 

 

 

MEDICARE

 

Once U.S citizens reach the age of 65 or if a person is legally disables, they are eligible for Medicare, an insurance program provided by the United States Federal Government .As you work throughout your life, a certain amount is deducted from each Pay check you receive to fund the Medicare government account.

 

 

 

Medicare limits the amount it will pay for certain procedures similar to an HMO plan. Some Doctors/Hospitals accept this as full payment. Other doctors/hospitals require the patient to pay for the remainder of the bill.

 

For example, if a patient had gall bladder surgery, let’s say Medicare will only pay $400 for doctor expenses and $600 for Hospital expenses. The doctor and Hospital have two options at
This point. They can accept $400 and $600 as full payment. Or, for example, if the doctor normally charges $500 for the procedure And Hospital charges $800 for the procedure, the doctor can bill the patient for the remaining $100(or once again accept $400 as full payment and the hospital can invoice the patient for $200.

 

The Medicare program offers Part A and Part B coverage. Part A is for hospital services and is free of cost. Part B is for medical (doctor office visits) and out –patient services and requires a monthly premium as well as an annual $100 deductible.

 

MEDICAID

 

Medicaid is a state government funded medical insurance provided to welfare recipients (poor people), disabled (physical or mentally) OR AS A SUPPLEMENT TO MEDICARE. State share in financing the program and determine the eligibility and benefits consistent with federal standards. However, some doctors and hospitals do not accept Medicaid patient because the government’s allotted payments are comparatively lower.

 

Primay Vs Secondary Insurance