The Role of Insurance in the Medical Office

Medicare Part B or medical insurance helps cover medically necessary doctor’s visits,
Out-patient care, home health services, durable medical equipment, and other medical services.
Items Covered
• Abdominal aortic aneurysm screenings, but must have a referral.
• Alcohol misuse screening and counseling
• Ambulance services
• Blood from a blood bank at no charge
• Bone density screening
• Cardiovascular disease screening
• Cervical and vaginal cancer screenings
• Chemotherapy
• Colonoscopy
• Diabetes screening
• EKG (electrocardiogram screening)
• Emergency department services
• Eyeglasses (limited services)
• Flu shots
• Home health services
• Kidney dialysis services & supplies
• Laboratory services
• Out-patient mental health care
• Occupational therapy
• Out-patient hospital services
• Out-patient medical & surgical supplies and services
• Physical therapy
• Pneumococcal shot
• Limited prescription drugs There are any more tests, procedures, and services under Medicare Part B. The insurance

Representative (Michael) I spoke with was extremely informative. Along with being well

versed in the terminology, he offered to email me the handbook instead of mail. He did

this in a timely matter also (about an hour).

Health insurance in the medical office is a vital key not only for patients but for the

providers as well. People who are uninsured receive less medical care and less timely

care, and have worse health outcomes. Providers who accept insurance have higher

cliental and are more focused on the patients care.

KEY ELEMENTS OF MANAGED CARE

1) Restricts choice of M.D.’s/other providers
• Provider network
• Gatekeeper
2) Oversees discrete treatment decisions
• Utilization review
• Prior authorization
3) Creates financial incentives for M.D.’s/other