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Insurance

Terms in this set (61)

A bed patient in a hospital is called
inpatient
One who acts for the insured or the carrier in a claim is called
adjuster
A request for payment under an insurance contractor bond is called
claim
Payment made periodically to keep an insurance policy in force is called
premium
A person or institution that gives medical care
provider
Specific hazards or perils listed in an insurance policy for which the insurance company will not pay is called
exclusions
Benefits in the form of cash payments rather than service are called
indemnity
An amount the insured must pay before policy benefits begin is called
deductible
An organization that offers insurance against losses in exchange for a premium
carrier
Health insurance that provides protection against the high cost of treating severe or lengthy illness or disabilities
catastrophic
A patient receiving ambulatory care at a hospital or other health facility without being admitted as a bed patient
outpatient
An illness or injury that prevents an insured person from performing one or more of the functions of his regular job
partial disability
A previous injury, disease or physical condition that existed before the health insurance policy was issued
preexisting condition
One who belongs to a group insurance plan
subscriber
A sum of money provided in an insurance polity, payable for covered services
benefits
To prevent the insured from receiving a duplicate payment for losses under more than one insurance polity
coordination of benefits
A requirement under a health care policy dictates that the insured be responsible for a % of covered services
coinsurance
Period of time after the beginning of the disability for which no benefits are payable
elimination period
Insurance designed to offset medical expenses resulting from catastrophic or prolonged illness or injury
major medical
An unexpected event which may cause injury
accident
A doctor who agrees to accept an insurance companies preestablished fee as the maximum amount to be collected
participating physician
An illness or injury that temporarily prevents an injured person from performing their regular job
temporary disability
Insurance plans that pay a physician's full charge if it does not exceed his normal charge, or does not exceed the amount normally charged for the service by other physicians in the are, and is reasonable
usual, customary and reasonable
The period of time in which a notice of claim or proof of loss must be filed is called
time limit
A program designed for certain needy and low income people, the blind, the disabled and members of family receiving aid to dependent children
Medicaid
A health program for people age 65 under social security
Medicare
A civilian health and medical program of the uniform services
Champus
A form of insurance paid by the employer providing cash benefits to workers injured or disabled in the course of employment
Workers Compensation
A recap sheet that accompanies a Medicare or Medicaid check, showing breakdown and explanation of payment on a claim
explanation of benefits
A type of insurance whereby the insured pays a specific amount per unit of service and the insurer pays the rest of the cost
copayment
In insurance, greater coverage of diseases or accident, and greater indemnity payment in comparison with a limited clause
comprehensive
A rider added to a policy to provide additional benefits for certain conditions
dread disease rider
An interval after a payment is due to the insurance company in which the policy holder may make payments, and still the policy remains in effect
grace period
A skilled nursing facility for patients receiving specialized care after discharge from a hospital
extended care facility
Payment for hospital charges incurred by an insured person because of injury or illness
hospital benefits
An agent of an insurance company who solicits or initiates contracts of insurance and services the policy holder for the insurer
Insurance agent
A method of charging whereby a physician presents a bill for each service rendered
fee-for-service
The Champus fiscal year
October 1 - September 30
In the CHAMPUS program, if the patient lives within 40 miles of a uniformed service hospital and the necessary services are not available at that service hospital, for treatment in a civilian or physician office
nonavailability statement
When children are covered by both policies of parents and whichever parent's birthday falls first in the calendar year, that parent's insurance is the primary coverage
birthday rule
A statement from the insurer that is sent to the patient with a detailed account of " who paid which bills"
assignment of benefits
When prior authorization must be obtained before a patient is admitted to the hospital
pre-certification
The geographical area served by a HMO
service area
The patient information sheet is completed immediately upon arrival at the medical office by the
patient
After the initial visit, the patient case history is dictated by the
physician
If both husband and wife carry insurance coverage that overlaps, the insured's coverage is considered
primary
Transference of words into numbers for use of computers in claim processing
coding
The date when the insurance goes into effect
effective date
When the health care provider is paid a fixed amount for each person treated regardless of service provided
capitation
When a subscriber belongs to a group where they have a choice of a participating or non-participating physician where the non-participating physician receives a lower level of benefits
Preferred Provider Organization
A list of approved professional services for which the insurance company will pay and how much it will pay
fee schedule
Rules that insurance companies have that services be outpatient or impatient
stipulations
A government health insurance for spouses and dependent children of veterans who are totally disabled or who have died in service-related activities
CHAMPVA
A combination of a charge slop, statement, and an insurance report form
superbill
A listing of medical procedures and treatments, known as Physicians' Current Procedural Terminology
CPT-4 Codes
Public or private organizations that pay or insure medical expenses on behalf of recipients
third party payer
A Medicare coding system called Health Care Financing Administration Common Procedures Coding System
HCPCS
The insurance abbreviation HMO stands for
Health Maintenance Organization
An organization offering members prepaid medical services emphasizing good health maintenance
Health Maintenance Organization
Medicare Insurance has two parts - Part A and Part B. Part A covers
hospital insurance
Part A of Medicare is financed by
contributions paid by employees
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