Healthcare Terminology

4. The process where, before a patient can be admitted to the hospital or receive other types of specialty services, the managed care company must approve of the proposed service in order to cover it.
7. The services that members are entitled to receive based on their health plan.
10. Financial protection against the healthcare costs caused by treating disease or accidental injury.
11. The amount of money that a person must pay for his or her healthcare, including: deductibles, co-pays, payments for services that are not covered, and/or health insurance premiums that are not paid by his or her employer.
14. People who have some type of health insurance but not enough insurance to cover their the cost of necessary healthcare.
16. A person's healthcare costs are paid by their insurance or by the government.
18. An insurance program for people with low incomes who are unable to afford healthcare. Although funded by the federal government, this insurance is administered by each state.
19. A group of affiliated contracted healthcare providers (physicians, hospitals, testing centers, rehabilitation centers etc.), such as an HMO, PPO, or Point of Service plan.
20. People who do not have health insurance of any type.

1. A federal program of medical care benefits created in 1965 designed for those over age 65 or permanently disabled.
2. The amount of money, or value of certain services (such as one physician visit), a patient or family must pay before costs (or percentages of costs) are covered by the health plan or insurance company, usually per year.
3. Bills for services.
5. The person enrolled in a health plan.
6. Treatments or other services for which a health plan pays at least part of the charge.
8. A defined set of benefits provided to all people covered under a health plan.
9. An individual or institution who provides medical care, including a physician, hospital, skilled nursing facility, or intensive care facility.
10. The specific services and procedures covered by a health plan or insurer.
12. An account that lets workers set aside pretax dollars to pay for medical benefits, childcare, and other services.
13. The amount paid periodically to buy health insurance coverage. Employers and employees usually share the cost of premiums.
15. Flat fees or payments (often $5-10) that a patient pays for each doctor visit or prescription.
17. A percentage of providers' fees that managed care companies hold back from providers which is only given to them if the amount of care they provide (or that the entire plan provides) is under a budgeted amount for each quarter or the whole year.