Medical Plans and Managed Care: Rapid Fire

What this video covers

• How basic medical policies differ from major medical coverage, including cost sharing, exclusions, and limits
• How health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans commonly handle networks, referrals, and out-of-network care
• Why network status and covered-service status answer different questions, and how a missing referral can affect cost sharing
• When preauthorization, concurrent review, and retrospective review happen, and why preauthorization is not final claim approval
• How case management coordinates providers and care settings for complex needs
• How coordination of benefits determines primary and secondary coverage, including the birthday rule and other ordering rules
• How an explanation of benefits (EOB), coordination of benefits, and subrogation differ, including what to report to a secondary plan