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Insurance

Horizontales
Standard form used by offices to file claims
Certification from an insurance company approving the cost and medical necessity of a procedure PRIOR to performance.
A medical condition already present at the time of purchasing an insurance plan.
Individual paying for insurance
Government funded health insurance for lower income families and individuals.
Law passed in 2010 to make health insurance more affordable. Prevents health insurance from denying coverage of pre-existing condition
A fixed percentage paid by the patient after the deductible has been met
Assignment of Benefits. When a patient authorizes payments from insurance companies to be paid directly to providers.
A way to determine the primary coverage when a patient is double covered
A fixed amount paid by a patient for a specified visit
Plans sold on government exchanges.
Stands for Primary Care Physician. A PCP is the main provider for the insured but can refer to other specialists when required (acts as a gatekeeper).
Allows claims to be tracked faster and status to be checked regularly
Allows employees injured in the workplace due to a work-related task to be covered, injury must be reported and filed
A monthly fee paid by a patient or customer to an insurance company.
Health insurance for veterans who were injured or killed in the line of duty. Covers veterans, spouses and dependents. Also called Civilian health and medical plan
Private health insurance plan which requires a PCP. You can see out of network providers but a referral is required.
Verticales
A system that allows data to be exchanged electronically which results in faster payment
Private insurance plan that requires a PCP. Generally regarded as the cheapest plan with no coverage for out of network care.
Amount a patient must pay before insurance coverage begins
Reviewing services prior to provision to determine medical necessity
10 digit code used to identify providers
Insurance companies pay a fixed amount on a per member per month basis
Act that allows providers to manually submit claims on a paper form rather than electronically for special reasons
Private health plan that requires a PCP. Can see out of network specialists with a referral only.
Health insurance for children 0-17 who's families earn above the threshold for medicaid but not enough for private insurance.
A notice given to a patient by the insurance company detailing what benefits were received and billed. Stands for Explanation of Benefits.
Claims submitted electronically
Government funded insurance plan for citizens 65 years of age and older. Contains parts A-D.
Private health plan with most freedom. Do not need a referral to see out of network but it does cost more. Most expensive plan.
Government health insurance for active military service personnel