Mr. G’s Insurance Terms
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Deductible | Amount of money a patient must pay for services BEFORE health insurance pays its share of the bill.
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Co-Insurance | A specific percent of the expenses are shared by the patient and the insurance company; for example, in a 80 - 20 percent co insurance, the company pays 80% and the patient pays 20%.
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Co-payment | An out of pocket fee aid by a person with health insurance at the time a covered service, such as an office visit or prescription, is received.
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Premium | The monthly fee paid by the subscriber (patient) for insurance coverage; may be deducted from payroll check.
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Preferred Provider Organization or PPO | A type of managed care: practitioners are grouped together to provide health care and agree to a set fee paid by the insurance company.
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Health Maintenance Organization or HMO | Type of managed care provider that focuses on preventive care.
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Point of Service Plans or POS | A hybrid of a HMO and PPO. Have smaller deductibles and co payments, but they require the patient to get a referral before seeing a specialist.
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Medicare | Health insurance for those 65+ and disabled - funded through social security taxes
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Medigap | A supplement health insurance plan used to covers health care cost not covered by Medicare.
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Medicaid | State-funded insurance for blind, disabled, low income people
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CHIP | Health insurance for children that do not qualify for Medicaid.
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TRICARE | Health care plan provided for active duty personnel, family, retired military personnel, and survivors of military personnel
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Worker's Compensation | Health insurance through the employer that pays for the healthcare of workers injured on the job
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Managed care | The general term used by insurance companies to describe the attempt to provide quality health care at minimal cost. Used to limit healthcare costs.
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HIPAA | Health Insurance Portability and Accountability Act - health care law that gave standard way to transfer patient files and protect CONFIDENTIALITY.
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Protected health information or PHI | All individually identifiable personal information obtained through health care. Includes a patients name, medical record number, birth date, Social security number, address, telephone number, email, employer and so on.
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Electronic Health Record or EHR | A medical record that contains information from all of the clinicians involved in a patients care which can be created and managed by authorized clinicians and staff across more than one health care organization.
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Explanation of Benefits or EOB | A detailed account of each claim processed by the insurance company. which is sent to the patient as notification of claim or denial.
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Created by:
rotechams
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