It’s always fun learning new terminology, like when we were learning instant messaging slang. We LOLed all the time and would say TTYL to our besties, but what’s not fun is when you hear someone talking about something and you don’t really know what language they’re speaking. We’ve cut through the noise to bring a few of the terms that can truly get confusing, no matter how many times we hear them.
Accountable Care Organization (ACO)
A healthcare organization made of doctors, other healthcare professionals, and hospitals sharing in the provision of value-based care to a specific population of patients.
This is also referred to as “retainer medicine”. Patients would pay for a yearly membership to have access to services that would not be covered in their insurance, in some cases a provider would charge a flat fee on a monthly basis.
Preferred Provider Organization (PPO)
A network of physicians, clinics, labs and hospitals gives the freedom to choose specialists, facilities, and primary care physicians without referrals.
Health Maintenance Organization (HMO)
Gives coverage to doctors and facilities within the network. Patients need to have a primary care physician that orchestrates the care and issues referrals to see specialists or for procedures.
Consumer-Driven High Deductible Health Plans
Known as a “high deductible”. The combined freedom of a PPO with the lower premium of an HMO. The deductible ranges from $1,250 for an individual to $2,500 for a family.
It’s another combo of HMO and PPO. Allows the no-deductible and low co-payment model of an HMO, and is guided by a primary care physician. It can offer out-of-network benefits like a PPO, where you face a high co-payment and must meet a deductible for out-of-network care unless it was referred by the primary care physician. This kind of plan requires you to pay associated medical bills and submit reimbursement claims where necessary.
Now that we’ve covered all of this information, it’s time for us to TTYL (talk to you later) and TTFN (ta-ta for now), until the next time.
Gables Medical Billing has adapted to the ever-changing medical billing environment, modifying and adding to its services to proactively meet the needs of its clients.