Across
- 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
Down
- 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.