Healthcare Insurance Essentials

2. An approved list of physicians, hospitals, and other providers.
6. An organization that processes claims and provides administrative services for another organization. Often used by self-funded plans.
12. An order from a primary care provider for a patient to see a specialist or get specific medical services.
14. For insurance to pay for services, this must be submitted.
15. A set dollar amount that a patient or policyholder must pay before insurance starts to pay for the services rendered.
17. A designated person who receives funds from an insurance policy.
19. A medical procedure that is not deemed medically necessary.
20. An insurance plan for individuals who are injured on the job or become ill due to job-related circumstances

1. A set dollar amount that a patient or policyholder must pay at each office visit before insurance starts to pay.
3. Term for somebody who is poor, needy, or impoverished.
4. The length of time a patient must wait for disability insurance to pay after the date of injury.
5. A low- income patient may be eligible for this insurance.
7. A process required by some insurance carriers in which the provider obtains permission to perform certain procedures or services.
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 decision making process used by managed care organizations to manage healthcare costs.
11. The amount paid or to be paid by the policyholder for coverage under the contract, usually in periodic installments.
13. The process of confirming the healthcare provider's qualifications.
16. Relatives of military personnel are covered by this government insurance plan.
18. A document sent by the insurance company to the provider explaining the allowed charge amount.