FH Reimbursement 101

Banishing Gobbledygook, Jargon and Slang

FH Reimbursement 101 is a series of informational guides that use good old-fashioned “plain speak” to help consumers better understand the healthcare system and how to use it.

This series is intended to empower consumers by giving them the information they need to help navigate the twists and turns of healthcare reimbursement.  We hope that this easy-to-follow tutorial, in combination with the FH Medical Cost Lookup and FH Dental Cost Lookup  tools that allow consumers to look up estimated charges for out-of-network services, will result in better-educated consumers who can make informed decisions to protect their health and their finances.

Each guide in the series offers comprehensive answers to common questions and directs consumers to resources where they can find additional information if necessary. Among the questions examined in these guides are:

• What do the terms in my EOB mean?

• What is the difference between an HMO, a PPO, a POS, and an EPO? 

• What are the differences between in-network and out-of-network care, and how can those differences affect me?

• How do health plans typically share costs with their members? (e.g. what are the differences between co-pays, co-insurance, deductibles, and out-of-pocket maximums)?

Through efforts like these, FAIR Health seeks to help de-mystify the landscape of the healthcare system for the benefit of all consumers. FH Reimbursement 101 is just one part of the “curriculum,” and we look forward to introducing more important healthcare consumer innovations.
 
FH Reimbursement 101 addresses a range of topics including:

• What is the difference between emergency care and urgent care?
• Why is it possible to be billed for an out-of-network provider at an in-network facility?
• What are the most common type of dental plans?
• What does it mean to use Medicare fees as a basis to determine out-of-network care?
• What is a Flexible Spending Plan, and how does the federal healthcare reform bill impact such plans?
• What is a modifier on a claim form and how may it impact your level of reimbursement for out-of-network services?
• What is the difference between an insured and self-insured plan?
• How do health plans establish their networks?
• How do I appeal a reimbursement decision?
• What questions should you ask your Insurance Plan before going out-of-network?
• What questions should you ask your Provider?
• Understanding Anesthesia Reimbursement
• Understanding High Deductible Health Plans