Final answer:
When a pharmacy requests payment from an insurance company for a prescription it has dispensed to a patient, the process is known as filing a reimbursement claim. Pharmacies receive reimbursement based on the services provided, which is part of a broader fee-for-service health financing system.
Step-by-step explanation:
When a pharmacy requests payment from an insurance company for a prescription it dispensed to a patient, this process is known as a reimbursement claim. In the context of a fee-for-service health financing system, medical care providers, including pharmacies, receive reimbursement according to the cost of services they provide. This is in contrast to health maintenance organizations (HMOs), where providers are paid based on the number of patients rather than services rendered.
The pharmacy submits the relevant claim documentation to the insurance provider to verify that the prescription is covered under the patient's plan and to request payment for the medication provided. This system aims to align the interests of the pharmacy with the financial mechanisms of the healthcare system. The insurance company then assesses the claim and reimburses the pharmacy accordingly.