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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.

Alice Edwards
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nWhat are the pros and cons of payment incentive programs, coverage,and eligibility requirements□Why is it important to understand the eligibility requirements ofvarious 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. Medicarerequirements is usually for people of the age 65 or older with the acceptanceof people with end stage diseases such as renal disease, and cancer forexample. The cons are policy holders can be responsible for deductibles andcopays, need a referral to see a specialist, and are limited choices ofproviders who are in-network. The pros are preexisting medical diagnoseswill not be denied in claims, no monthly premium payment. Therequirements for Medicaid are very simple be deemed medically needy andbelow a certain tax bracket. They also provide medical coverage forpregnant women and children whose parents need insurance for a child, theelderly must be an United States citizens. The pros are no monthly premiumsand affordable health care with little to no out-of-pocket cost. The cons arethe limits of coverage and the limit of providers in the network. Therequirement for Medigap is to be the age of 65 years of age and haveMedicare Part B. The pros are some or all medical fees paid for and hospitalcoverage. The cons are the monthly premiums can differentiate and may behigh, and not all plans cover Part B deductible. Tricare requirements is to bea soldier or a family member of one, be a sole survivor of one, and or exspouse. The pros are comprehensive coverage for health, dental, andprescription, having discounted share cost . The cons are out of pocket costs,copayments, and varied paperwork, requirements are to be a spouse andchild of a vet, be a servicer spouse or child of a vet that died in service orfrom a disability from service. The pros can be matched with a Medicareadvantage plan. The cons are it does not cover dental. It is important tounderstand the insurance requirements so the patient can get the servicesthey need in a timely manner, as well as understand the financialresponsibility prior to service. The final understanding is to make sure theirmeet their copay and yearly deductible, so the health facility and the patientdoes not get penalized. A medical coder and biller can determine eligibilityby reading the patient's plan as well as looking up the covered service codes.
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