medical insurance and billing key terms medical insurance and billing key terms

Third party payer

All health plan

Deductible

An amount of money a patient must pay out-of-pocket before insurance begins to pay

Coinsurance

The policyholder and the insurance company share the cost of service 18:20

Copayments

Amount of money paid at the time of service sit by insurance company

Assistant of benefit

Form soil by patient to allow the provider to be paid directly by the insurance company

Participate provider

Providers that agreed to write off the difference between the amount chart and the amount by the insurance company

Allowed amount

The maximum amount of insurance company will pay for a survey or product

Advance beneficiary notice (ABN)

Form provided to patient when provider believes speedy care will not cover service. Patient would be responsible for payment.

Explanation of benefit (EOB)

Statement of insurance company to patient outline amounts billed, amount allowed , amount applied to deductible, coinsurance, and co-pay outline what insurance will be paying to provider on patient behalf

Pre-authorization (per certification)

Process required by insurance companies where providers obtain provision to perform procedures or service or referrals to patient to a specialist

Medicaid

Cover low income, and mentally indigent

Tricare

Covers military Personnel and dependents

What is Workers' Compensation?

Workers' Compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue their employer for negligence.

CHAMPVA

covers surviving spouse, and dependent child a veteran who has died as a result of service related disabilities

Children’s health insurance program (CHIP)

Provide providers low-cost health coverage to children’s and families that earn too much money to qualify for Medicare

Workers compensation

Covers workers against lost wage due to accident on the job. Contract between employer and insurance company

Managed care health plans

Plans that provide provider healthcare for payments. care is through a network of providers and hospitals