Insurance Terms 1
A set dollar amount you have to meet before health insurance will start helping to pay.
What is a premium.
Insurance provided by the federal and state government for people with low incomes.
What is Medicaid?
What does CMS stand for?
What is Centers for Medicare and Medicaid Services?
A request for your health insurance to review a claim/denial.
What is appeal?
A fixed dollar amount you may have to pay for a service at the time of the service.
What is co-payment?
Independent non-profit facilities that provide healthcare services.
What is a community hospital?
What does ACA stand for?
What is the Affordable Care act?
A provider that has a contract with your health insurance to provide services at a discount.
What is preferred provider?
Depending on your insurance, this may need to be completed in order to receive a medical service or durable medical equipment (DME). This is done to make sure all services/care is medically necessary.
What is pre-authorization/prior-authorization?
Health insurance available to all people 65 years and older and those with certain disabilities.
What does CHIP stand for?
What is Children's Health Insurance Program?
Costs you share with your insurance provider AFTER your deductible is met. Typically you are responsible for 20% of the cost.
What is co-insurance?
Healthcare services that help to improve a patient's function due to an illness or accident.
Ex: A patient learning to talk again after suffering a stroke.
What is rehabilitation services?
A for-profit facility that provides medial services and is owned and operated by groups such as businesses and physicians.
What is a private hospital?
What does FPL stand for?
What is Federal Poverty Level?
The most amount you would ever have to pay during a year/policy period for medical services.
What is out-of-pocket limit/max?
A provider that does not have a contract with your insurance to provide services. You will need to pay more money to see this type of provider.
What is a non-preferred provider?
For those people that are "dual eligibles" or have two forms of health insurance, which insurance is considered the primary and which is the secondary?
If a patient is eligible for Medicare, that will always be primary and the secondary insurance will be Medicaid or a private insurance (BCBS, Aetna, etc). If a patient is NOT eligible for Medicare, then their private insurance (BCBS, Aetna, etc.) will be primary and Medicaid will be secondary.
What does HIPAA stand for?
What is Health Insurance Privacy and Accountability Act?