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Insurance Terms

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Term
Definition
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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