Who's Who
Don't Break the Rules
Show Me the money
Grab Bag
100
The provider that ?coordinates patient care; Sometimes referred to?as a “gatekeeper”.
Who is the ?Primary Care Provider (PCP)?
100
A formal recommendation by a provider for a patient to be evaluated or treated by a different provider.
What is a referral?
100
A fee that is paid by the patient before every visit, if required by the insurance plan.
What is a co-payment?
100
An insurance plan type that requires a Health Saving Account to accompany it.
What is a High-Deductible Health Plan (HDHP)?
200
An expert in a specific area ?of medicine or surgery.
Who is a Specialist?
200
The approval of specialty care.
What is an authorization?
200
An amount of money the patient must pay before insurance pays any portion of the bill.
What is a deductible?
200
The acronym is DME.
What is Durable Medical Equipment?
300
Family members covered under the subscriber’s health insurance.
Who are dependents?
300
The managed care term for a provider or hospital where the cost of services has been negotiated with an insurance company.
What is an in-network or contracted?
300
When the costs are split between the insurance company?and the insured patient.
What is co-insurance?
300
This is the person that is legally and financially responsible for a visit (actually, this has nothing to do with Managed Care).
Who is the Guarantor?
400
Insurance term for the person who has a health insurance policy in his or her name.
Who is the subscriber or policy holder?
400
When a patient goes to a specialist without a PCP referral.
What is a self-referral?
400
This up-front charge is typically different for primary care versus specialty care.
What is the co-payment?
400
Supplemental services provided?during treatment (such as labs, radiology, physical therapy).
What are ancillary services?
500
3 of 4 different departments at UCH where an appointment for primary care may be made.
What are Family Medicine, ?Internal Medicine, WISH and Seniors?
500
This must be obtained from an insurance company before services are provided, or payment for care may be denied.
What is an insurance authorization?
500
The co-payment amount typically paid by Medicare patients.
What is $0?
500
The rule in Colorado to determine whose insurance should be primary when a minor is covered by both parents.
What is the Birthday Rule?
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