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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


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


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

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