Benefits
This type of visit is free under the (ACA)... yet members still ask," Are you SURE"?
What is Preventive Care?
When the member calls we give out information right away.
What is False?
If the parents are separated or divorced and there is nothing in a court decree establishing financial responsibility for health care expenses, then the parent with custody's coverage will be primary for the dependent children.
What is Custody Rule?
This status determines whether your bill is cute... or catastrophic.
What is in-network?
This happens when a provider says, "Insurance paid...but I still want more," and sends the member the leftover bill like it's a tip.
What is balance billing?
Reaching this annual financial milestone means your insurance finally starts paying the whole bill, usually around December 30th at 11:59 PM
What is the out-of-pocket maximum?
This privacy law means receptionists must yell your name to the entire waiting room like a Starbucks barista, but they can't say why you are there.
What is HIPAA?
This type of group will calculate payment considering the provider's total billed charge, the allowed benefit, and the amount paid by the primary carrier.
What is Secondary Carrier?
This requirement means CareFirst wants to approve the party before the provider throws it.
What is Prior Authorization?
This number is what CareFirst says the service SHOULD cost- not the provider's fantasy.
What is Allowed Amount?
Under the ACA, this annual routine visit is "100% free," right up until you accidentally mention a stubbed toe and the doctor bills it as a specialist consultation.
What is Wellness Exam?
This is the easiest way to remember HIPAA Verification.
What is 3+1?
If the member is enrolled with just one health insurance, this is what CareFirst would be considered as.
What is Primary?
This disaster occurs when a provider bills under the wrong provider identifier, causing the claim to get denied faster than a bad credit card.
What is incorrect NPI billing?
Having a procedure at an in-network hospital or surgery center, out-of-network providers who treat you (i.e, anesthesiologists, radiologists, or pathologists), you are liable to be balance billed.
What is no they CANNOT balance bill you?
This is the ironic term for the monthly subscription fee you pay just for the luxury of having an insurance card sitting silently in your wallet.
What is a Premium?
This acronym refers to any health data that can be linked to a specific individual, which HIPAA is designed to protect.
What is PHI (Protected Health Information)?
The group will make this based on the contract requirements up to the billed charge, but its actual payment will not exceed the allowed benefits.
What is Reimbursement?
This plan type is perfect for people who refuse to be told what to do- but it comes with premiums higher than a Beyoncè concert ticket.
What is PPO?
You are fully protected from surprise bills during emergencies visits in your home state, but if you have this restrictive 3-letter type of plan, a non-emergency specialist visit across state lines will instantly get you balance billed for the whole ride.
What is an HMO?
Coverage for services rendered in Birthing Centers vary based on product and jurisdiction for these two plans.
What is Grandfathered and PPACA?
This Federal Privacy Law is often misspelled by members "HIPPA," "HIPPO," or " that privacy thing y'all do," even though it actually stands for this five-word phrase.
What is Health Insurance Portability and Accountability Act ?
This process determines which insurance pays first when a member has more than one active health plan.
What is Coordination of Benefits?
This plan lets members see ANY provider, ANYWHERE, with no network- but they pay upfront like they're buying a used car.
What is an indemnity plan?
The federal No Surprises Act was passed to stop this medical specialist from acting like an uninvited wedding crasher on your surgery bill.
What is Anesthesiologist?