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10 terms

Medical Insurance - Chapter 5

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balance billing
collecting the difference between a provider's usual fee and a payer's lower allowed charge from the insured
consumer-driven health plan
Type of medical insurance that combines a high-deductible health plan with a medical savings plan which covers some out-of-pocket expenses
family deductible
a fixed, periodic amount that must be met by the combination of payments for covered services to each individual of an insured/dependant group before benefits from a payer begin
HMO
a managed health care system in which providers agree to offer health care to the organization's members for fixed periodic payements from the plan; usually members must receive medical services only from the plan's providers
out of pocket expense
expenses the insured must pay before benefits begin
PPO
a managed care organization structrured as a network of health care providers who agree to perform services for plan members at discounted fees; usually plan members can receive services from non-network providers for a higher charge
referral number
authorization number given by a referring physician to the referred physician
Resource Based Relative Value Scale
federally mandated relative value scale for establishing Medicare charges
usual fee
fee for a service or procedure that is charged by a provider for most patients under typical circumstances
walkout receipt
a medical billing program report given to a patient that lists the diagnoses, services provided, fees, and payments received and due after an encounter