CMS Glossary

3. Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.
7. The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay.
8. A request for your health insurer or plan to review a decision or a grievance again.
10. The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.

1. A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.
2. Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service.
4. A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.
5. A complaint that you communicate to your health insurer or plan.
6. Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.
9. A benefit your employer, union or other group sponsor provides to you to pay for your health care services.