Beneficiary: A person who receives benefits of any insurance plan or policy.
Claim: A request for payment for services submitted by the provider.
Coinsurance: A specified percentage of covered expenses which the insurance carrier requires the beneficiary to pay toward eligible medical bills.
Co-pay or Co-payment: A specific set dollar amount contracted between the insurance company and the beneficiary to be paid prior to any services rendered.
Covered Services: Services for which an insurance policy will pay.
Deductible: A specified dollar amount of medical expenses which the beneficiary must pay before an insurance policy will pay.
Guarantor: The guarantor is the person legally responsible for charges incurred.
Explanation of Benefits (EOB): A statement from an insurance company showing the processing of a claim.
Medically Necessary: Treatments or services that insurance policies will pay for as defined in the contract.
Non-Covered Services: Services for which an insurance policy will not provide payment. These services are to be paid by the patient at the time of service.
Pre-Certification/Authorization: A service-specific requirement that your insurance company’s approval be obtained before a medical service is provided.
Provider: A person or organization that provides medical services.