| What is a
Co-payment? |
| |
The amount of
your bill that is your responsibility
to pay. Also known as a ‘co-pay’. |
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|
| What is a
Deductible? |
| |
The amount of your bill that you must pay for medical services, often before
your insurance company starts to pay. |
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|
| What is Co-insurance? |
| |
The percentage amount
of your bill that you have to pay. |
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|
| What is Out-of
Pocket Costs? |
| |
The total amount, per policy term
of your bill that
you have to pay. |
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|
| What is an
ABN? |
| |
Advance Beneficiary Notice (ABN) is
a notice the hospital or doctor gives
you before you are treated, telling
you that Medicare will not pay for some
treatment or services. The notice is
given to your so that you may decide
whether to have the treatment and how
to pay for it. |
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| What are
Non-Covered Charges? |
| |
Charges for medical services denied
or excluded by your insurance. You may
be billed for these charges. |
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|
| What is an
EOB? |
| |
Explanation of Benefits (EOB/EOMB)
is the notice you receive from your
insurance company after getting medical
services from a doctor or hospital.
It tells you what was billed, the payment
amount approved by your insurance, the
amount paid, and what you have to pay. |
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|
| What is COB? |
| |
Coordination of Benefits (COB) is
a way to decide which insurance company
is responsible for payment if you have
more than one insurance plan. |
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| What is HIPAA? |
| |
HIPAA – Health Insurance Portability
and Accountability Act. This federal
act sets standards for protecting the
privacy of your health information. |
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|
| What is Prior-Authorization,
Pre-Admission Approval or Certification? |
| |
An agreement by your insurance company
to pay for your medical treatment. Doctors
and hospitals ask your insurance company
for this approval before providing your
medical treatment. |
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|
| What is a
Pre-Existing Condition? |
| |
A health condition or medical problem
that you already have before you sign
up to receive insurance. Some health
insurers may not pay for health conditions
you already have. |
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|
| What is Managed
Care? |
| |
An insurance plan that requires patients
to see doctors and hospitals that have
a contract with the managed care company,
except in the case of medical emergencies
or urgently needed care if you are our
of the plan’s service area. |
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|
| What is a
Network? |
| |
A group of doctors, hospitals, pharmacies,
and other healthcare experts hired by
a healthcare plan to take care of its
members. |
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|
| What is an
Advanced Directive (Healthcare)? |
| |
Written ahead of time, a healthcare
advanced directive is a written document
that says how you want medical decisions
to be made if you lose the ability to
make decisions for yourself. A healthcare
advanced directive may include a Living
Will and a Durable Power of Attorney
for healthcare. |
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|
| What is Coding
of Claims? |
| |
Translating diagnoses and procedures
in your medical record into numbers
that the computers can understand. The
diagnosis is received from your physician
according to the medical treatment performed
and documented in your medical record.
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