Trauma Survivors Network - provided by ATS

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A Program of the ATS


Major medical insurance, the most common type of health insurance, covers basic and advanced medical expenses. These plans are often subsidized by an employer, and the money spent on these health insurance plans is often tax-free. Though each plan may vary in coverage provided, these plans will cover anything from a trip to the doctor or the emergency room to treatment for advanced diseases or cancer.

Health insurance is bought by paying a monthly premium to a health plan. The health plan will in turn help you pay your medical expenses as they arise, either by covering the entire procedure or by covering a portion of the costs (co-pay). Each plan will often incorporate a deductible, which is the amount of money that must be spent out-of-pocket before you coverage begins, which helps to keep premium rates from sky-rocketing.

The rising costs of health care impact everyone, but people with disabilities are often the hardest hit. You must examine a benefits summary or an outline of coverage—the description of policy benefits, exclusions, and provisions. A summary makes it easier to understand a particular policy and compare it with others.

Today, when people talk about broad health care coverage, instead of using the term "major medical," they are more likely to refer to fee-for-service or managed care. These terms apply to different kinds of coverage or health plans. Moreover, you’ll also hear about specific kinds of managed care plans: health maintenance organizations or HMOs, preferred provider organizations or PPOs, and point-of-service or POS plans.

HMOs, PPOs, and fee-for-service plans often share certain features, including pre authorization, utilization review, and discharge planning. For example, you may be asked to get authorization from your plan or insurer before admission to a hospital for certain types of surgery. Utilization review is the process by which a plan determines whether a specific medical or surgical service is appropriate and/or medically necessary. Discharge planning is an approach that facilitates the transfer of a patient to a more cost-effective facility if the patient no longer needs to stay in the hospital. For example, if, following surgery, you no longer need hospitalization but cannot be cared for at home, you may be transferred to a skilled nursing facility.

Almost all fee-for-service plans apply managed care techniques to contain costs and guarantee appropriate care; and an increasing number of managed care plans contain fee-for-service elements. While the distinctions among plans are growing increasingly blurred, the number of options available to consumers increases every day.


Additional Resources:


Associated pages

A Guide to Quality Healthcare
Managed Care
Guide to Health Insurance