Written by Dr. Sameer Sippy | 

Medically Reviewed by The Medindia Medical Review Team  on Apr 19, 2013

About

A New Health Care Marketplace

Things have undergone a sea change since the 1970s, especially when majority of citizens in USA who had health insurance, also possessed Indemnity insurance. Indemnity insurance is frequently referred to as fee-for-serviceor traditional health insurance. Such a type of coverage generally gives the impression that the medical or healthcare provider (usually a doctor or hospital) will be paid a fee for each product or service provided to the patient— i.e. the individual or his/her family member covered under the health policy.

With fee-for-service insurance, an individual is free to go and approach the medical professional or physician of his/her choice and thereafter, he/she can submit a claim to the Insurance Company (or Insurer) for reimbursement. It is often observed that the medical practitioner or hospital will submit the health-claim on the individual’s behalf. Thereafter, the concerned policyholder or the claimant will only be reimbursed for the “covered” medical expenses under the ambit of the health insurance policy cover. The coverage details are listed in health policy’s benefits (or coverage) summary. When a healthcare product or service is covered under the customer’s policy, the concerned individual can expect reimbursement for some of the entire incurred cost, but generally does not cover the entire incurred cost towards healthcare expenses. This generally depends on the concerned policy’s coinsurance and deductibles, which varies drastically from product to product. Some portion of the medical bills may not reimbursed by the insurance company especially those expenses that are non-covered or excluded from the policy cover.

USA Healthcare Insurance

Nowadays, many Americans have availed health insurance policy cover and are generally enrolled in a managed care plan viz. Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO).

When health insurance is discussed, it generally implies the health insurance product or service that pays medical bills, hospital bills, laboratory bills and typically, prescription drug (or pharmacy) expenses. Such type of coverage includes Medicare and Medicaid -the two US sponsored government programs that provide health insurance coverage for certain categories of population viz. seniors, people with disabilities and individuals or families with low income. In addition tom this, there are other types of coverage as well, including disability insurance, long-term care insuranceand other insurance products or services that can offer additional financial protection for the individual and his/her family.

References:

  1. DEFINITIONS OF HEALTH INSURANCE TERMS - (http://www.bls.gov/ncs/ebs/sp/healthterms.pdf)
  2. Glossary of Insurance Terms - (http://www.ambest.com/resource/glossary.html)
  3. Patients & Consumers - (http://www.ahrq.gov/CONSUMER/insuranceqa/insuranceqa.pdf)

Latest Publications and Research on Overview on USA Healthcare Insurance

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Ari2011 Monday, August 29, 2011

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