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monetary compensation for physical impairment,pain and suffering, loss of earnings, or additional medical expenses as a result of the negligence.
any amounts paid toward the deductible by any member of the family will be added up to reach any deductible
any amounts which the patient pays toward their deductible in the last three months of the year will carry overy and will be applied to the next year's deductible
stipulates that if the coinsurance portion of a patient's bills reaches a certain amount, all subsequent claims will be paid at 100% of the allowed amount
common accident provision
States that only one deductible, under Major medical, will be taken for all members of family involved in the same accident.
Dollar value of each unit. Each 3rd party payer issues a list of conversion factors which varies from one region to another. This is multiplied by the number of units in the procedure.
allowable amount for that particular procedure assigned according to the particular CPT code
surgery recommended as an elective procedure when an alternative method of treatment may be preferable
determines whether the estimated length of time & scope of the inpatient stay is justified by the diagnosis & Symptoms.
files which are kept in batches or groups based on the date they were processed and the person who processed them
states that the plan covering the male employee is primary, and the plan covering the female employee is secondary
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