Health Insurance Terms
Types of treatment insurance will not pay for under certain conditions.
Exclusions
The process of examining a person’s condition or behavior to determine (find out) the problem.
Assess
A small amount (less than the whole bill) you must pay when you visit a healthcare provider.
Co-payment
The amount you pay for your health insurance every month.
Premium
The deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of healthcare services.
Care coordination
Physical changes, thoughts, feelings, or behaviors that cause problems with activities and daily living.
Disorders
A primary care provider’s order that will allow you to see a specialist under the terms of your health insurance plan.
Referral
A collaborative process to plan, seek, advocate for, and monitor services for health and human service needs.
Case management
Treatments that are considered by medical providers to be appropriate for treating a person’s symptoms.
Medically necessary
Approval from a health plan that may be required before you get a service or fill a prescription.
Pre-authorization
To evaluate a person’s medical, behavioral, or educational condition to determine what services the person needs.
Evaluation
Signs of disease that may include physical changes, thoughts, feelings, and behaviors.
Symptoms
A care provider whose services are not on the list of a certain insurance company’s contracted providers; this means the insurer may not cover the bill or cover less of the bill.
Out-of-network
A form that you sign giving permission for one health or educational provider to share information with another provider or organization.
Release of information
The span of care options (different types of care), ranging from a simple office visit to full inpatient hospital treatment.
Continuum of care