Insurance Terms
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| Private Insurance | show 🗑
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| Primary Insurance | show 🗑
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| Premium | show 🗑
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| show | double coverage (your work + parent's insurance)
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| show | individual pays for their insurance
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| Self Pay | show 🗑
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| show | special programs by state and federal government that provides insurance
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| Co-Pay | show 🗑
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| Deductibles | show 🗑
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| show | provided to pt by insurance company as a statement that details what services were paid, denied, or reduced in payment
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| Co-Insurance | show 🗑
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| show | an EOB sent to the provider from the insurance carrier; contains multiple pts and providers and electronic funds transfer info/ check for payment
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| Advance Beneficiary Notice (ABN) | show 🗑
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| show | pts 65+ for Part A (hospitalization), Part B (routine office visits), Part D (prescription coverage)
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| Tricare | show 🗑
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| show | covers surviving spouses and dependent children of veterans who died in service-related disabilities
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| show | health insurance to the medically indigent population through a cost sharing program between federal government and states
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| Worker's Compensation | show 🗑
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| show | offers low-cost health coverage for children birth-18; designed for families who earn too much money for Medicaid, but cannot afford to buy private health coverage
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| show | offered through an individual's employer who will usually pay a portion of the premium and then deduct the remainder of the premium from the employee's pay
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| show | insurance plans that an individual funds themselves; pts might pay the entire premium themselves if they are self-employed
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| Health Maintenance Organization (HMO) | show 🗑
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| show | medical care arrangement in which medical professionals and facilities provide services to subscribed clients at reduced rates; medical/ healthcare providers called preferred providers
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| show | can be used to pay for medical expenses; funds are not taxed until the time of withdrawal, any amount not used stays in the account and accrues interest after a year; must be used in conjunction with a high deductible plan
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| Flexible Spending Account (FSA) | show 🗑
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| ICD-10-CM | show 🗑
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| show | type of fraud where healthcare workers submit inaccurate billing codes to receive inflated reimbursements
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| CMS-1500 | show 🗑
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| show | document/ form required by insurance companies that is used when a provider wants to send a pt to a specialist
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| Participating Provider | show 🗑
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| show | total amount owed on an account
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| Debit | show 🗑
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| show | money owed to the provider
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| show | debts incurred and not yet paid
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| show | monetary balance in an individual's favor
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| Assets | show 🗑
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| show | amounts owed; debt
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| Electronic Medical Record (EMR) | show 🗑
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| Electronic Health Record (EHR) | show 🗑
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