Health Insurance

5. A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan's network
8. the permission of your insurance plan that they may require in order to see a recommended specialist, doctor, hospital, or type of treatment.
9. ________ of benefits is required to figure out who pays first when 2 or more health insurance plans are responsible for paying the same medical claim.
10. AA flat fee for certain medical expenses
12. The shared cost of a covered health care service after the patient reach their annual deductible. It is usually calculated as a percentage.
13. The most money you will pay during a year for coverage.(OUT OF POCKET MAX)

1. The amount the patient pays for covered health care services before the insurance plan starts to pay
2. Consists of a plan that covers doctor bills, surgery and hospital costs
3. A plan that usually limits coverage to care from doctors who are INN or contracted with plan
4. What a doctor submits to your insurance company so they can get paid.
6. a managed care plan that provides maximum benefits if you visit an INN physician or provider, but still provides some coverage for OON providers
7. a one-time contract between an insurance company and an OON provider that allows a patient to receive medical services that are paid by their insurance company.
11. INN health care providers have contracted with the insurance company to accept certain negotiated
12. 90867,90868, 90869 are examples of what type of code?
13. means that we have not agreed to contracted rates with the insurance company