The training and treatment demands of residency typically far overshadow learning about the mechanics of health insurance coverage. That changes very quickly as training ends and practice decisions are made, but there’s help from the AMA to learn the basics of how care is paid for.
An 18-minute training module, “Introduction to Health Insurance,” is designed to familiarize residents with the terminology and how to envision effectively dealing with health plans once in practice. It is one of the AMA GME Competency Education Program offerings, which include nearly 30 courses that residents can access online, on their own schedule.
Among the program’s experts are several who contributed to the AMA’s Health Systems Science textbook, which draws insights from faculty at medical schools that are part of the Association’s Accelerating Change in Medical Education Consortium.
Modules cover five of the six topics—patient care, practice-based learning and improvement, interpersonal and communication skills, professionalism, and system-based practice—within the Accreditation Council for Graduate Medical Education’s core competency requirements. The sixth requirement, medical knowledge, is one that is typically addressed during clinical education.
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The module offers frank advice as well as the fundamental terms a physician should know.
It acknowledges that it’s a very complicated industry that physicians have to navigate in order to be paid for their services. “It's a job you can't do alone, so you should partner with others to help you stay informed,” says the module. Health plans’ rules can be subject to sudden and substantial changes. The module goes on to provide guidance on where physicians can seek support.
Residents who go through the module will learn to:
- Identify the key players in the health insurance business
- List the ways health care can be paid for including different types of health insurance
- Differentiate between Medicare and Medicaid
- Describe how the physician fits into the health insurance industry in practice
They also will be armed with information on deductibles, coinsurance and copays.
Even though many Americans are uninsured, the majority of patients will have at least some form of coverage. Those who take the module will learn about coverage, exceptions and other nuances in Medicare, Medicaid, employer-sponsored plans, catastrophic and supplemental insurance.