Insurance and Billing Terms

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Across
  1. 2. A request made for direct payment or reimbursement for medical services that an insured person has obtained.
  2. 4. A group of health care providers contracted with an insurance company offering services to plan members for specific pre-negotiated rates. (2 words, 1 dash)
  3. 5. An eligible person, other than the member, (generally a spouse or child), who has health care benefits under the member’s policy.
  4. 9. The cost a patient would need to pay depending upon their plan. (3 words, 2 dashes)
  5. 13. The amount a patient will need to pay before an insurance company begins to pay for services. This amount resets at the beginning of a new benefit period, usually yearly.
  6. 14. State government administered coverage for eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.
  7. 15. Holds all the charges, coding, and payments for an encounter. It also ties together the insurance and guarantor information.
  8. 16. Federal health insurance programs for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.
  9. 17. A type of health plan that provides health care coverage to its members through a network of doctors, hospitals and other health care providers.
Down
  1. 1. Coverages that have limitations and because of these limitations Advocate Health chooses not to participate. (2 words)
  2. 2. A dollar amount specified by a patient's insurance plan that they pay for a medical visit.
  3. 3. The person or group that assumes responsibility of payment for a debt owed to Advocate Health.
  4. 6. The ability to be covered by a health plan, including definition of specific benefits for which a member is qualified, and the timeframe of coverage.
  5. 7. A type of health plan that supplies services at a higher level of benefits when members use contracted health care providers.
  6. 8. The percentage a patient will pay after an insurance company pays its agreed-upon percentage; e.g., your plan may cover 80% and you would pay the remaining 20%.
  7. 10. The entity that pays for the services rendered by a healthcare provider.
  8. 11. The portion of a patient's bill that the guarantor is legally responsible for paying. (2 words, 1 dash)
  9. 12. A doctor or other provider that does not have a contract with a patient's health plan. (3 words, 2 dashes)