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ALH 151

week2

QuestionAnswer
Authorization an approved referral
beneficiary individual entitled to receive benefits
benefits amount payable by an insurance company to an individual or company
capitation fixed payment method used in managed care to reimburse provider for patient enrollment
TRICARE insurance for active duty military and their families
CHAMPVA civilian health and medical program of the veterans administration
co-insurance policyholder and insurance company share cost of coverage
copayment money that is paid at the time of service by patient
dependents other individuals designated by the insurance covered under the insurance policy
eligibility describes whether a patient is entitled to coverage for a service
EOB explanation of benefits
guarantor person responsible for paying medical bill
insured persons covered by insurance
HMO Health Maintenance Organization
Medicare insurance for disabled or elderly
medicaid insurance for people without funds
policy holder person who carries insurance
premium amount paid for the insurance by policy holder
referral insurance term used when PCP wants to send patient to another physician
preauthorization obtaining permission before service is rendered
Created by: kristy.marsh