Insurance Terms
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Private Insurance | show 🗑
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Primary Insurance | show 🗑
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Premium | show 🗑
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show | double coverage (your work + parent's insurance)
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Self Insured | show 🗑
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show | people who have NO COVERAGE and would be expected to pay at the time of service
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Government Plans | show 🗑
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Co-Pay | show 🗑
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show | specific amount of money a pt must pay out of pocket before the insurance carrier begins paying for services
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Explanation of Benefits (EOB) | show 🗑
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Co-Insurance | show 🗑
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show | an EOB sent to the provider from the insurance carrier; contains multiple pts and providers and electronic funds transfer info/ check for payment
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show | form that Medicare pts will sign when the provider thinks Medicare won't pay for a specific service/ item
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Medicare | show 🗑
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Tricare | show 🗑
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show | covers surviving spouses and dependent children of veterans who died in service-related disabilities
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Medicaid | show 🗑
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Worker's Compensation | show 🗑
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Children's Health Insurance Policy (CHIP) | show 🗑
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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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show | insurance plans that an individual funds themselves; pts might pay the entire premium themselves if they are self-employed
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show | health insurance plan that usually limits coverage of care from doctors who work fo/ contract with the HMO; generally won't cover out-of-network care except in an emergency; may require you to live/ work in its service area to be eligible for coverage
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show | medical care arrangement in which medical professionals and facilities provide services to subscribed clients at reduced rates; medical/ healthcare providers 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; allows for specificity and laterality of coding for payment
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show | type of fraud where healthcare workers submit inaccurate billing codes to receive inflated reimbursements
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CMS-1500 | show 🗑
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show | document/ form required by insurance companies that is used when a provider wants to send a pt to a specialist
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Participating Provider | show 🗑
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show | 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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Credit | show 🗑
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Assets | show 🗑
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show | amounts owed; debt
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Electronic Medical Record (EMR) | show 🗑
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show | EMR+ other info to be used between facilities
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