Provider excess loss insurance: a safety net for risky business.
Capitation agreements are challenging healthcare providers to keep the cost of delivering care at or below their agreed-upon capitated payment. To protect themselves when this cannot be accomplished, providers are purchasing provider excess loss insurance, which reimburses providers if their patient costs exceed a deductible or per-member-per-month dollar threshold. It is important that managers understand differences among the three general types of providers excess loss insurance: per-person, aggregate, and carve-out.
Phillips
C T
CT
Medical Alliance Partnership, Minneapolis, MN, USA.
D002204:Capitation Fee; D005377:Financial Management, Hospital / Q000379:methods*; D006279:Health Maintenance Organizations / Q000191:economics; D007351:Insurance, Liability / Q000145:classification*; D012051:Reimbursement Mechanisms; D012308:Risk Management / Q000191:economics / Q000379:methods*; D013997:Time Factors; D014481:United States