Healthcare Insurance Essentials

5. A process required by some insurance carriers in which the provider obtains permission to perform certain procedures or services
7. The process of confirming the healthcare provider's qualifications
12. An insurance plan for individuals who are injured on the job or become ill due to job-related circumstances
13. The amount paid or to be paid by the policyholder for coverage under the contract, usually in periodic installments
15. A medical procedure that is not deemed medically necessary
18. An organization that processes claims and provides administrative services for another organization. Often used by self-funded plans
20. The set dollar amount that a patient or policyholder must pay before insurance starts to pay for the services rendered

1. A set dollar amount that a patient or policyholder must pay before insurance starts to pay at each office visit
2. Relatives of military personnel are covered by this government insurance plan
3. An approved list of physicians, hospitals, and other providers
4. A document sent by the insurance company to the provider and the patient explaining the allowed charge amount, the amount reimbursed for services, and the patient's financial responsibilities
6. A decision-making process used by managed care organizations to manage healthcare costs
8. A health problem that was present before new health insurance coverage started
9. A referral that is used in an emergency situation, as indicated by the provider
10. A designated person who receives funds from an insurance policy
11. Term for somebody who is poor, needy, or impoverished
14. An order from a primary care provider for a patient to see a specialist or get specific medical services
16. The length of time a patient waits for disability insurance to pay after the date of injury
17. For the insurance to pay for services, this must be submitted
19. A low-income patient may be eligible for this insurance