Medical Terminology
What is Insurance Premium
The amount of money you payregularly (monthly, quarterly, orannually) to keep your healthinsurance coverage active.
What is Medicare
Seniors (age65+) and disabled individuals. Federally regulated.
PPO
Preferred Provider Organization:
Billed Charge: $250
Allowed Amount: $180
Insurance Paid: $144
Contractual Adjustment: $70
Deductible: Met
What is the Co-insurance: ?
$36
What is Healthcare Facility
A place where people receivemedical care and services. Thiscan include hospitals, clinics,nursing homes, and outpatientcare centers.
What is Medicaid
Low-incomeindividuals& families. State to state differences.
HMO
Health Maintenance Organization:
Billed Charge: $150
Allowed Amount: $120
Insurance Paid: $96
What is the Contractual Adjustment: ?
$30
What is Explanation of Benefits (EOB)
A statement from the healthinsurance company that explainswhat medical treatments andservices were paid for. An EOB isnot a bill; it’s a summary of howinsurance benefits were applied.
What is Tricare
Uniformed service members, retirees, and their families around the world.
EPO
Exclusive Provider Organization:
Billed Charge: $700
Allowed Amount: $400
Non-Covered Charge: $150
Insurance Paid: $300
Deductible: $500 (met)
What is the Patient Responsibility: ??
$250
What is Deductible
Amount of money to be paideach year, before Insurance willbegin to pay.
What is CHIP
Children’sHealth Insurance Program: For families that earn too much money for Medicaid.
POS
Point of Service:
Billed Charge: $450
Allowed Amount: $250
Insurance Paid: $200
Deductible: $1,000 (met)
What is the Contractual Adjustment: ?
$200
What is Co-pay
A fixed amount paid for a coveredhealth care service, usually collected at the point of service.
What is IHS
Indian Health Services: for federally recognized American Indians and Alaskan Natives.
CA
Contractual Adjustment
Billed Charge: $600
Allowed Amount: $450
Insurance Paid: $0
Deductible: $750 (not met)
What is the Patient Responsibility: ??
$150