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A point of service plan is a type of managed care health insurance plan in the United States. It combines characteristics of the health maintenance organization (HMO) and the preferred provider organization (PPO). [1] The POS is based on a managed care foundation—lower medical costs in exchange for more limited choice. But POS health ...
Level III codes, also called local codes, were developed by state Medicaid agencies, Medicare contractors, and private insurers for use in specific programs and jurisdictions. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) instructed CMS to adopt a standard coding systems for reporting medical transactions.
Blue Shield was developed by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians. [9] [10] In 1939, the first official Blue Shield plan was founded in California. In 1948, the symbol was informally adopted by nine plans called ...
PPO. The Preferred Provider Organization plan is the most popular for those with employment-based insurance (currently 47% of them, in fact). PPOs allow the most flexibility in that people can ...
Unlike EPO members, however, PPO members are reimbursed for using medical care providers outside of their network of designated doctors and hospitals. However, when they use out-of-network providers PPO members are reimbursed at a reduced rate that may include higher deductibles and co-payments, lower reimbursement percentages, or a combination ...
Blue Cross and Blue Shield of Alabama (BCBSAL) is a nonprofit health insurance company headquartered in Birmingham, Alabama. The company was founded in 1936, provides coverage to more than 3 million people and is a member of the Blue Cross and Blue Shield Association (BCBS). BCBSAL employs nearly 5,000 people, which includes almost 3,500 people ...
Blue Cross Blue Shield of Michigan (BCBSM) is an independent licensee of Blue Cross Blue Shield Association. [1] Currently it is headquartered in 600 E. Lafayette Blvd. in downtown Detroit. Blue Cross Blue Shield of Michigan, a nonprofit mutual insurance company, provides and administers health benefits to more than 4.3 million members residing ...
Once the out-of-pocket maximum is reached, the health plan pays all further costs. [ 2 ] CDHC plans are subject to the provisions of the Affordable Care Act , which mandates that routine or health maintenance claims must be covered, with no cost-sharing (copays, co-insurance, or deductibles) to the patient.