BI Terminology

1. Federal health insurance program for U.S citizens who are at least 65 years of age or are a qualifying disabled person
6. A request that can be submitted to ask an insurance plan to re-determine coverage for a non-formulary drug
7. Specific to pharmacy benefits, a decision made by the insurance plan to determine whether a health care service is medically necessary
8. Fixed out-of-pocket costs charged to patients for services rendered
10. A type of medical insurance plan that provides benefits for a broad range of healthcare services both inpatient & outpatient
11. The estimated cost of the insurance plan
13. Federal and state government funded program for eligible low income adults and seniors, parents and children, individuals with disabilities and pregnant persons
16. Written or oral expression of dissatisfaction regarding the plan or provider

2. The percentage of the total cost of services the patient will be responsible for
3. The amount that must be paid out of pocket before the insurance company will begin paying towards most covered expenses
4. Medicare Plan the covers prescription drugs
5. abv. the maximum amount a patient will pay during a policy period before the plan begins to pay 100% of the allowed amount
9. Abv. Plans that employers use often through a third party vendor, that guide patients towards utilizing patient assistance programs rather than the employer covering the cost
12. Supplemental insurance that can assist with patient out of pocket costs associated with copays, coinsurances or deductibles
14. A request for the plan to review a decision or grievance
15. Abv. Medicare financial assistance that lowers the cost of Part B and D premiums as well as lowering the cost of prescription drugs