Care A health care plan in which monthly premiums are paid for a complete package of services through an HMO or similar type of provider. A benefit choice that HMOs may offer that allows enrollees to receive certain services outside of the plans provider network, at some additional cost. Medigap Insurance Provides insurance coverage to supplement or fill the gap in Medicare s reimbursement for covered services, and is regulated by Federal and State law. The doctor you have chosen in a managed care plan to address your overall health care needs. A group of practicing physicians and other health care professionals under contract with the federal government to review the quality of Medicare services received.
PROs also promote patient s rights and process inpatient appeals.
Appeals Procedure by which a beneficiary or enrollee may question a decision made by Medicare, HMOs or other plans denying payment for Medicare covered services.