1) Plan sponsor or plan subscriber, are they same?

2) How to check patient has multiple health plans?Some individuals who purchase
on and off-exchange health plans may receive an advance premium tax credit
(APTC)
3) HMO and PPO
4) out of pocket cost
5) can we use modifier with one CPT code
6) Copay , Coinsurance

Points to remember;

** Government Insurances****
-Medicare( federal insurance given by government to their citizens with certain
conditions like 65 years old,
disability, and hospice.
-Medicaid ( this coverage is given to those citizens who's income is less than the
minimum threshold decided by different
states.Basically for low income individuals.

****Private Insurances*****

-Aetna, Cigna, BCBS, Humana and these insurances have multiple plans . And patient
took these plans
which suits to them.One of the popular plan of these insurances are;

1)Health Maintenace organization:

Insurances ask patients that which PCP(prefereed care provider) would you
choose .
for example PCP is like a family doctor and he gives you medicine but if you will
need a specilist checkup then in this plan (HMO)
you need a referral .

NOTE: if the patient has an HMOplan then the AR team find the referal for that
claim, otherwise the claim got denied.

2)Preferred Provider organization:

patients have freedom to choose their provider but the patient has to bear high
copay , deductible amount.