Health Insurance Terminalogy

2. The directing of a patient to a specialist physician by the primary care provider. Most managed care plans and some other insurance plans require the primary care provider to obtain prior authorization.
3. A person with financial responsibility for a bill who may or may not also be a patient.
4. Enrollment status related to a health insurance plan.
5. A percentage of the allowed charge for health services, which the patient is responsible for paying.
7. Rules followed by insurance companies so that no claim is reimbursed at more than 100% of the charges.
8. The government insurance program for low-income individuals and families that is funded both by the federal government and by each individual state.
9. The health care practitioner chosen by a patient to provide general medical care and also to determine and authorize additional medical services the patient may require.
10. A physician who has a contractual agreement with a third-party payor.
12. The federal health insurance program that provides insurance coverage for the elderly, permanently disabled, and individuals with end-stage renal disease.
17. The amount paid by insurance for health care services.
18. An amount of money that an insured person must pay annually before health services are covered by the insurance plan.
19. A fixed amount of money that the patient must pay for any health care service.

1. Verification from a patient's insurance carrier that a procedure is covered by the patient's insurance and/or agreement, after review, that the test or procedure is medically appropriate.
4. A statement issued by the insurance carrier explaining reimbursement for specific procedures.
6. A government health insurance program that covers dependents of military veterans with service-connected disabilities.
7. A method of paying for insurance in which a fixed amount is paid to the provider per member for a specific time period regardless of the amount of care provided.
10. Verification from a patient's insurance carrier that a procedure is covered by the patient's insurance and/or agreement, after review, that the test or procedure is medically appropriate.
11. Payment for a covered service under a health insurance plan.
13. The individual who has a specific insurance plan.
14. An insurance carrier's official list of covered medications to be used by network providers.
15. An amount of money paid in a given period to purchase health insurance.
16. A person who can receive benefits under an insurance plan.