Insurance Terminology
Amount of money to be paid each year, before Insurance will begin to pay
What is a Deductable?
Children’s Health Insurance Program: For families that earn too much money for Medicaid.
What is CHIP?
Billed Charge: $150
Allowed Amount: $120
Insurance Paid: $96
Contractual Adjustment: ?
$30
A fixed amount paid for a covered health care service, usually collected at the point of service.
What is a Co-pay?
Doctor who deals with Gums
What is a periodontist ?
Uniformed service members, retirees, and their families around the world.
What is Tricare?
This payer is a charitable organization that providesfinancial assistance for medical expenses to individualswho cannot afford healthcare. They partner with hospitalsand clinics to offer free subsidized care to those in need.
Who is Other payor?
Billed Charge: $150
Allowed Amount: $120
Insurance Paid: $96
Contractual Adjustment: $30
Deductible: Met
Co-insurance: ?
$24
A statement from the health insurance company that explains what medical treatments and services were paid for. An EOB is not a bill; it’s a summary of how insurance benefits were applied
What is an Explanation of Benefits ?
Doctor who delas with nervous system.
Who is a Neurologist?
A professional who delivers medical care and services to patients. This includes doctors, nurses, therapists, and other medical practitioners.
What is a healthcare Provider?
A type of healthinsurance that individualin the U.S. can buy fromprivate companies. It’sNOT provided by thegovernment.
What is Private Payor?
Billed Charge: $250
Allowed Amount: $180
Insurance Paid: $144
Contractual Adjustment: $70
Deductible: Met
Co-insurance: ?
$36
A card issued by a health insurance company that is presented when receiving medical services. It contains important information like your policy number and coverage details.
What is a Health Insurance card?
A male midwife nurse
What is an accoucheur ?
A service available in every state where individuals, families, and small businesses can shop for and enroll in affordable health insurance.
What is a Health Insurance Marketplace?
Indian Health Service for federally recognized American Indians and Alaskan Natives.
What is IHS?
Billed Charge: $400
Allowed Amount: $250
Insurance Paid: $0
Contractual Adjustment: $150
Deductible: $1,000 (not met)
$250
Providers or health care facilities that are or are not part of a health plan.
OON
Doctor who specialize in diagnosing and treating conditions related to the feet, ankles, and lower legs.
What is a Podiatrist?
A code used on insurance claims to provide additional information about the payment or denial of a claim. These codes explain why claim was paid differently than expected or why it was denied.
What is a Remark Code?
The process by which insurance payers review and make decision on healthcare claims submitted by providers.
What is an Adjudicator?
Billed Charge: $700
Allowed Amount: $400
Non-Covered Charge: $200
Insurance Paid: $320
Deductible: $500 (met)
Contractual Adjustment: ??
Patient Responsibility: ??
Contractual Adjustment: $300
Patient Responsibility: $220
The percentage of costs paid for acovered health care service after the deductible has been met.
What is co-insurance?
The scientific study of bones, encompassing their structure, function, development, and pathology.
What is Osteology?