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Chapter 3 provides basic, essential information about hospital insurance. There are a number of different types of medical insurance coverage. Because one of the main jobs of a patient account specialist is to handle patients' questions about what their insurance has paid, how much money they owe, and why, an experienced patient account specialist needs to know the basic facts about medical insurance coverage. Many patients have coverage through one of the employer group health plans (EGHPs) offered by their employers. Some patients—perhaps a third of acute care patients—have Medicare coverage. Other patients have medical insurance through another government-sponsored program. This chapter compares the coverage of the two parts of the Medicare program, Part A and Part B, and also discusses Medicaid, TRICARE, CHAMPVA, and workers' compensation. Insurance companies restrict patient benefits to no more than 100 percent of a bill. The chapter describes the methods used to control payments to beneficiaries who have more than one insurance plan, whether they hold two private plans or Medicare and other coverage. Learning ObjectivesCompare primary, secondary, and supplemental insurance.Describe the way in which an insurance company controls payment to a beneficiary who has more than one insurance plan. Briefly describe the coverage that the two main parts of the Medicare program provide to beneficiaries. Describe the purpose of the Medicare Secondary Payer program. Discuss the eligibility requirements and coverage of the Medicaid, TRICARE, and CHAMPVA programs. Discuss the purpose of workers' compensation. |