Insurance Terms
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| show | Provided by a person's employer
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| Primary Insurance | show 🗑
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| Premium | show 🗑
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| show | Double coverage (ex. your work and your parent's insurance)
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| show | Individual pays for their insurance (usually for people who are self employed)
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| show | People who have no coverage and would be expected to pay at the time of service. Some places will offer special pricing for self paying individuals
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| show | Special programs by state and federal government that provides insurance for the elderly, indigent, and for children
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| Co-pay | show 🗑
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| Deductibles | show 🗑
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| Explanation of Benefits (EOB) | show 🗑
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| show | A percentage of the total cost that an individual must contribute toward each service
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| show | An EOB sent to the provider from the insurance carrier. Is similar to the EOB, the RA contains multiple patients and providers. Also includes the electronic funds transfer information or a check for payment.
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| show | A form that a Medicare patient will sign when the provider thinks Medicare won't pay for a specific service or item.
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| show | Patients 65 years or older for Part A (hospitalization), Part B (routine office visits), Part D (prescription coverage)
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| show | Authorizes dependents of military personnel to see civilian practitioners
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| CHAMPVA | show 🗑
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| Medicaid | show 🗑
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| show | A state legislative law that protects employees against the cost of medical care resulting from a work-related injury
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| show | Offers low-cost health coverage for children from birth through age 18. Designed for families who earn too much money to qualify for Medicaid, but cannot afford to buy private health coverage. $35-$50/year
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| show | Offered through an individual's employer who will usually pay a portion of the premium and then deduct the remainder of the premium from the employee's pay.
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| Individual Policies | show 🗑
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| show | A type of health insurance plan that usually limits coverage of care from doctors who work for or contract with the HMO. Generally won't cover out-of-network care except in an emergency. May require you to live or work in its service area to be eligible
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| show | A medical care arrangement in which medical professionals and facilities provide services to subscribed clients at reduced rates. PPO medical and healthcare providers are called preferred providers.
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| Health Savings Account (HSA) | show 🗑
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| Flexible Spending Account (FSA) | show 🗑
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| show | International Classification of Diseases, Contains approx. 55,000 more codes than the previously used ICD-9-CM system, allows for reporting of disease and newly recognized conditions, allows for specificity and laterality of coding for payment
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| show | Using billing codes that reflect a more severe illness than actually existed or a more expensive treatment than was provided
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| CMS-1500 Form | show 🗑
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| show | A document or form required by insurance companies that is used when a provider wants to send a patient to a specialist
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| show | This means that the provider and the insurance company have agreed between the amounts charged and approved what will and will not be reimbursed.
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| show | The total amount owed on an account
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| Debit | show 🗑
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| show | Money owed to the provider
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| Accounts Payable | show 🗑
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| show | A monetary balance in an individual's favor
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| show | The entire saleable property of a person, association, corporation or estate applicable or subject to the payment of debts
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| Liabilities | show 🗑
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| Electronic Medical Record (EMR) | show 🗑
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| Electronic Health Record (EHR) | show 🗑
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