Health Insurance Terminalogy

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Across
  1. 3. An amount of money that an insured person must pay annually before health services are covered by the insurance plan.
  2. 7. A fixed amount of money that the patient must pay for any health care service.
  3. 8. 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.
  4. 10. 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.
  5. 14. A percentage of the allowed charge for health services, which the patient is responsible for paying.
  6. 15. The amount paid by insurance for health care services.
  7. 16. A physician who has a contractual agreement with a third-party payor.
  8. 17. An amount of money paid in a given period to purchase health insurance.
  9. 18. insurance The insurance company that must be billed first for any individual.
  10. 20. The individual who has a specific insurance plan.
  11. 21. Rules followed by insurance companies so that no claim is reimbursed at more than 100% of the charges.
Down
  1. 1. An insurance carrier's official list of covered medications to be used by network providers.
  2. 2. The federal health insurance program that provides insurance coverage for the elderly, permanently disabled, and individuals with end-stage renal disease.
  3. 4. Enrollment status related to a health insurance plan.
  4. 5. A statement issued by the insurance carrier explaining reimbursement for specific procedures.
  5. 6. A person who can receive benefits under an insurance plan.
  6. 9. 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.
  7. 11. 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.
  8. 12. Payment for a covered service under a health insurance plan.
  9. 13. 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. 19. The government insurance program for low-income individuals and families that is funded both by the federal government and by each individual state.