A
It is a Protection against Loss or any Damages in exchange of a Premium.
Insurance
Any Individual or entity who provides medical services is called?
Provider
Visiting the provider within 36 months
Established Patient
It’s a risk coverage given for any health issues for any current or future condition.
Health Insurance
Contract or Agreement between an individual and payor.
Policy
Visiting the provider after 36 months from the last visit.
New Patient
3 P’s of U.S. Healthcare
Provider, Patient, Payer
Any & every individual who is eligible to get the benefits under the policy.
Beneficiary
Receiving treatments more than 24 hours.
Inpatient Services
An Individual buys the plan/Policy as per his choice and pays the premium
Individual Health Insurance
The time gap between the enrolment date and the effective date.
Cooling Period
Physician who refers a patient to the specialists.
PCP, Referring Physician
Physician with expertise who provides the treatment or service to the patient on the Date of Service.
Specialist/Rendering Physician.
The time gap between the effective date and the date beginning which insurance will be responsible for a payment on pre-existing diseases.
Waiting Period
Cost Sharing paid by the Insurance & the remaining is paid by patient in the absence of a secondary Insurance.
Coinsurance
A document signed by the patient, taking responsibility of payment for services given by the provider, only when insurance refuses to cover the benefits
Waiver of Liability
Allows plans that provide health to determine their respective payment responsibilities. Either primary, secondary etc.
Coordination of Benefits
The small dollar value paid by the patient to the provider before the physician starts rendering the services.
Copay
A fixed annual dollar value which is to be paid by the subscriber to the provider before his/her insurance company starts reimburse the health care cost.
Deductible
Any amount paid monthly/quarterly/yearly by the subscriber to the insurance to avail the benefits of the policy.
Premium
If there is a overpayment made by insurance company to the provider, then the insurance company will adjust by deducting the amount from another patient claim.
Offset
A document signed by the patient, to authorize the provider to receive claim payment directly from the payer.
ASSIGNMENT OF BENEFITs (AOB)
A document signed by the patient, authorizing provider to share patients information with a insurance or medical billing company for billing purpose.
RELEASE OF INFORMATION (ROI)
A system of medical reimbursement wherein the provider is paid a monthly fee, per covered patient by an Insurance company which is a total reimbursement for all the services for all the patient’s. This is paid only to PCP.
Capitation
The recovery by Insurance for any debt by reducing present or future payments and applying the amount withheld to the indebtedness.
Recoupment