Final answer:
A list of fixed specified amounts paid by insurance for covered services refers to co-payments, which are fixed out-of-pocket amounts paid by insured individuals after meeting their deductible and before insurance covers the rest. Health insurance may also include co-insurance, where the insured pays a percentage of costs, varying by plan. An alternative to fee-for-service is an HMO, which operates on a fixed payment per patient.
Step-by-step explanation:
The list of fixed specified amounts that the carrier will pay toward the cost of covered services refers to a structured payment system within a health insurance plan. These are known as co-payments or co-pays, and they represent a fixed amount that the insured individual must pay for specific healthcare services after the deductible has been met and before insurance coverage kicks in. For instance, this could be a fee like $20 for a regular doctor’s office visit or $250 for an emergency room visit, which the insured person pays out-of-pocket. Once the deductible is paid, health insurance policies also may include co-insurance, where the insured person pays a certain percentage of the healthcare costs (for example, 20% of the costs, while the insurer pays the remaining 80%).
In contrast to fee-for-service arrangements, where providers are reimbursed for each service they provide, a Health Maintenance Organization (HMO) is another structure of health care financing. An HMO receives a fixed amount of money per patient enrolled, regardless of how many services that individual uses. These models are examples of how health insurance can be administered to provide healthcare coverage while sharing costs between the insurer and the insured.
Understanding the terms deductible, co-payment, and co-insurance is critical for policyholders to comprehend their financial responsibilities when accessing healthcare services.