Ch 3 Legal issues

The primary mechanism of payment for medical services in the United States

Which of these is not part of the NATA code of ethics?

Services that an insurer offers to pay for an insured individual

High School Athletes imply an assumption of risk when they decide to try out for a sport.

listing of the max payment amt that an insurance will allow for specified medical procedures

third party that limits where you can receive care. pay 100% of services rendered @ facility

When an individual fails to perform a legal duty

An athletic trainer relocates a dislocated shoulder

The person who takes out the medical insurance policy

Middle man between health care provider and insurance companies

Involves major hospital or hospital chain and its physicians.

A filed claim with all the necessary information that may be immediately processed

tort

Third party payer that requires you get care at their facility. Provide preventive measures.

The liability for damage caused by a product

General health insurance that covers illness, hospitalizations, and emergency care

Insurance coverage that pays remaining medical bills once gnrl health insurance has made pmnt

A form sent to an insurance company requesting payment for covered medical expenses

The failure to use ordinary or reasonable care

A person legally eligible for benefits based on his or her relationship with the policyholder

The state of being legally responsible for the harm one causes another person

act of commission

Insurance report accompanying all claim payments explaining how the insurance processed a claim

An athletic trainer doesn't clean out a laceration correctly and it becomes infected

Product liability holds the company who made the product liable unless...

provision requiring the policyholder to pay a specified percentage of each medical claim

An individual who has the responsibility of caring for an injury

health insurance program for people with low incomes

A periodic payment made to an insurance company by an individual policy

NOCSAE stands for

The most traditional form of billing for health care

An athletic trainer sutures a laceration

Specific length of time that individuals may sue for damages from negligence

Specified medical services, disorders, treatments & diseases that are uncovered in a policy

legally binding agreement between insurance company & physician describing the duties of both

Act of omission

When an individual commits an act that is not legally his to perform

Which of these is NOT important when proving any kind of negligence

Assumes that an individual is a person of reasonable and ordinary prudence

Form of reimbursement in which members make a standard payment each month

An athlete complains of abdominal pain. The ATC sends them back in without checking them out.

provider in a contract w/ insurance company to provide services to the beneficiaries of a plan

What are ethics?

When an individual improperly does something they have the legal right to do

covers accidents; usually for a specific activity such as sports

The individual assumes that some risk nor danger will be involved in the particular sport

A school nurse clears an athlete to return to play following a concussion

The average fee charged for a specified service or procedure in a defined geographic area

Establishes minimum performance standards for protective equipment that must be met 

the max amount that insurance will pay for each procedure or service performed.

amt owed on a yearly basisbefore the insurance company will begin to pay for services rendered

The Good Samaritan law protects someone who tries to help a victim, regardless of how they help

a person eligible to receive the benefits of a specific policy or program