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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 ...
In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at ...
[4]: 2 In the period between 1910 and 1940, early healthcare plans formed into two models: a capitated plan (essentially an HMO), and a plan which paid service providers, such as the Blue Cross and Blue Shield Plans. [4]: 2 One of the earliest examples is a 1910 "prepaid group plan" in Tacoma, Washington for lumber mills.
Resource-based relative value scale (RBRVS) is a schema used to determine how much money medical providers should be paid. It is partially used by Medicare in the United States and by nearly all health maintenance organizations (HMOs).
The Omnibus Budget Reconciliation Act of 1989 enacted a Medicare fee schedule, and as of 2010 about 7,000 distinct physician services were listed. [2] The services are classified under a nomenclature based on the Current Procedural Terminology (CPT) to which the American Medical Association holds intellectual property rights. [ 2 ]
In 1982, Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association (BCBS). [11] Prior to 1986, organizations administering BCBS were tax exempt under 501(c)(4) as social welfare plans. The Tax Reform Act of 1986 revoked the exemption, however, because the plans sold commercial-type insurance.
For dentists, the American Dental Association defines a usual and customary fee as "the fee an individual dentist most frequently charges for a specific dental procedure independent of any contractual agreement. It is always appropriate to modify the fee based on the nature and severity of the condition being treated and by any medical or ...
BlueCross BlueShield of South Carolina (BlueCross) is an independent licensee of the Blue Cross and Blue Shield Association. [1] BlueCross serves 21.5 million people through private business and government contracts. [2] BlueCross has several subsidiaries, two of which are affiliates licensed with the Blue Cross and Blue Shield Association.