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Texas Health Insurance Claims

Texas Health insurance claims can be confusing. With hundreds of terms and definitions, finding what you need and getting a straight answer is a long road. In part thirteen of this series we will continue to address the major types of health insurance as well as go over some of the definitions you will come across in your policy.
 
This time we will start with Texas Paid Business, Texas Paid Claims, and Texas Paid Claims Loss Ratio. Paid business is the insurance for which the insured, you, have completed the applications, medical examinations and have paid the first month’s premium, simple as that. Paid Claims are those which providers have received payments based on the health insurance plan you have signed to. The Paid Claims Ratio is possible the easiest of all the equations we’ve covered so far. The Paid Claims Ratio is simply the number of paid claims divided by the total premiums collected.
 
Now we will go in to Partial Disability, Partial Hospitalization Services, Permanent Partial Disability and Permanent Total Disability. What is Partial Disability in Texas? Partial Disability is a conditions in which the insured, you, is unable to perform all of your occupational duties due to injury of sickness but is still able to partake in some. Partial Hospitalization Services are those which provide help to patients who are mentally unhealthy or those whom are dealing with substance abuse. Partial Hospitalization covers the cost of outpatient treatments that can be used instead of follow-up inpatient treatments. Texas Permanent Partial Disability. This is a condition in which the insured is incapable of returning to pre-production output therefore hampering the insured’s earning capacity. Though the insured can no longer be at one hundred percent output, they are still able to work. Finally Permanent Total Disability is a condition in which the insured has been disabled to the point that they can no longer work to produce any output for the rest of their lives.
 
Lets review what a Physical Therapist is as well as go over Physician Contingency Reserve, or PCR, and Physicians Current Procedural Terminology, or CPT. A Physical Therapist is a person who has undergone medical training to provide rehabilitative services and therapy to aid in the restoration of bodily functions in the disabled. The Physicians Contingency Reserve, or PCR, is a portion of any claim, which is taken from the policy and held before the physician is paid. The health insurance provider holds the money and later returns it to the physician or continues to hold it to pay claims. Lastly, the Physician’s current Procedural Terminology, or CPT. This include any medical procedures or services that are preformed by a physician or other health care providers. This is used as the standard for the description of all services and procedures covered by the health care industry.