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# BAS 01 Ins Terms
# BAS 01 Insurance Terms
| Question | Answer |
|---|---|
| insurance | protection from financial loss |
| inpatient | a patient who stays longer than 24 hours in a hospital |
| outpatient | a patient who stays less than 24 hours in the hospital |
| how does an insurance company prove acceptance of a contract | 1. Signatures 2. Insurance card |
| what does it take to contract for health insurance | * legal age * sound mind * legally able to contract |
| medically necessary | services, procedures, and supplies that are reasonable for diagnosis and treatment. |
| Dx | diagnosis |
| Tx | treatment |
| COB | coordination of benefits. Law allows only 100% of allowable charges be paid through all insurances. |
| UCR | 1. usual fees: 2. Customary fees: 3. Reasonable fees: |
| birthday rule | a method of determining which insurance company pays first. |
| premium | cost of insurance policy |
| deductible | amount paid before the insurance company will pay. |
| Copayment | out-of-pocket expense of the patient at the time of service. |
| coinsurance | a percentage of service fees. Beneficiary shares expenses with the insurance company. |
| CC | chief complaint |
| morbidity | Disease |
| mortality | death that occurs from disease |
| subjective signs | what the patient feels. How the patient describes the condition. |
| Objective signs | physical characters that can be measured. |
| SOAP | evaluation for a doctor visit. Part of the patient's chart. |
| Medical chart | record of all visits, treatments, patient compliance, missed appointments |
| Balance billing | Doctor bills patient for the amount not paid by the insurance. |
| indemnity insurance | fee-for-service type |
| managed care | type of insurance that controls and monitors medical care. |
| out-of-pocket maximum | the maximum amount that the insured needs to spend before benefits will be paid in full by the insurance company. That |
| major medical | insurance policy that services long-term and high cost illnesses. |
| Basic medical | insurance that covers doctor visits and basic hospitalization and may cover surgery. |
| pre-existing condition | physical or mental condition incurred prior to obtaining insurance. Physical or mental condition treated before receiving insurance. |
| Medicare | Federal insurance for individuals age 65 and older. Certain other individuals such as, renal failure may use Medicare. |
| Medicaid | State insurance designed to help the needy. |
| CHAMPVA | Insurance for dependents of permanently disabled members. |
| PCIP | pre-existing condition insurance plan California subsidized insurance. |
| MSA | Tax free amount is put into a medical savings account to pay for medical expenses. |
| FSA | Premium is withheld from paycheck before taxes. |
| PCP | Primary Care Provider |
| Comprehensive Medical | An insurance policy that combines both Basic and Major medical insurance |
| PAR | Participating provider. A provider who has contracted with an insurance company. |
| non-PAR | A provider who has no contract with a particular insurance company. |
| COBRA | A law that allows a person to keep their health insurance if they quit their job. |
| enrollee | Person who has a managed care plan |
| policyholder | person with a fee-for-service plan |
| Tricare | Military insurance for: active, retired, and families of military |
| MTF | Military Treatment Facility |
Created by:
rjmtoss