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Authorization for the insurance company to send insurance payments directly to the health care provider , also an agreement w medicare that the provider will accept the remittance as full payment
A person eligible to receive insurance benefits
A method use to determine the primary insurance carrier when children are covered under both parent's insurance, th parent who birthday falls first, becomes the primary carrier
A health care insurance payment made to a provider based on a fixed amount per enrollee assigned to that provider; regardless of serviced provided
Insurance company that provides that policy and benefits
Service benefit program with no preminums for select family members of specific veterans, spouses and dependents for military personnell with perm, toal service related disability or spouses and dependents of military personnel who died from a service-rel
fixed percentage of covered charges contractually assumed by the insured party
small fixed fee that is collected at the time ofthe visit
fixed dollar amount that must be paid, met once a benefit year, befoe the insurance company beginsto cover medical expenses
a person covered under the primary insured's policy
conditions or circumstances that are not covered under the insurance plan
EOB (explanation of benefits)
a claim summary indicating what services were covered, what was not covered, and why, also referred to as a remittance advice
Fee for Service
A payment made to the health care provider for each service rendered
a list of a physician' customary charges, may incorporate insurne plan specific discounts
Health Maintenance Organization (HMO)
an association that provides all care to the insured person for a fixed fee, usually paid for the by insured or employer through a monthly premium, a copayment may or may not be required
Plan through which the insured person selects his or her own health care providers; an established amount or percentage of care cost is paid b the insurance plan on a fee service basis, deductibles n limits.