Terminology
Another name for "private insurance"
What is Third Party Liability?
What is Commercial Insurance?
This can be done through FSA's website, the front desk, or over the phone.
What is paying their deductible, co-pay, or sliding scale fee?
The age when a youth needs to sign their own forms.
What is 12?
A service that is commonly provided for persons who have Medicaid that is not a billable service under most commercial insurance policies.
What is case management? (Community Support, Mobile Crisis Response)
The amount you pay for covered health care services before your insurance plan starts to pay.
What is Deductible?
Services provided by a health care provider with a contractual agreement with the insurance company.
What is In-Network services?
How someone can pay for services if they have no insurance.
What is a Sliding Fee?
Medicaid clients have a RIN. Private insurances have ___________________.
What is a policy number?
The age when a person can no longer be covered on their parent's health insurance.
A fixed amount you pay for a covered health care service after you've paid your deductible.
What is a copay? (Co-insurance is same thing)
A type of health plan that provides health care coverage to its members through a network of providers only. No out-of-network benefits.
FSA will not be accepting HMOs. HMOs require prior approval from their primary care physician.
The time needed to cancel without being charged a fee.
What is 24 hours?
The form you need to fill out once someone has third party liability/private insurance
Always the payer of last resort.
What is Medicaid?
People cannot opt to not use their private insurances and use Medicaid only.
The ongoing amount that must be paid for your health plan. Usually deducted from a paycheck.
What is Premium?
A type of health plan that supplies services at a higher benefit level when utilizing contracted providers, but also often includes some benefit coverage for out of network providers.
What is a Participating Provider Option (PPO)?
An identifier that both the agency has and individual clinicians also need.
What is an NPI? (National Provider Identification number)
The central database that holds clinician's information for all insurance companies. Clinicians must create an account with them.
What is CAQH?
This could happen when you lose a job, or change jobs, have a baby, get married, turn 26, death of a family member.
What is a qualifying event?
The document that both the agency and the client receive that shows total benefits and client obligation to pay.
What is an Explanation of Benefits (EOB)?
An insurance plan subcontracts a set of benefits to another plan or network.
What is an insurance carve-out?
(E.g. Optum covers behavioral health for United Healthcare frequently.)
The number of co-pays a client can miss before pausing services?
What is three?
The place I can find the amount of my client's copay and deductible.
What is the Insurance Verification Form?
A contract between an insurance company and an out-of-network provider.
The most you have to pay for covered services in a plan year.
What is out-of-pocket maximum?