Insurance Term

Question 1

What is a advanced beneficiary notice (ABN)?

Answer 1

form provided to pt when prov believes medicare will not cover for services

Question 2

What is an allowed amount ?

Answer 2

maximum amounts third party payers will pay for procedure or services

Question 3

What is a copayment ?

Answer 3

amount of money pt must pay before being seen / at time of med service

Question 4

what is a co insurance ?

Answer 4

policy where policyholder and insurance will share the cost of covered losses in a ratio such as 80:20

Question 5

what is a deductible?

Answer 5

specific amnt of money pt must pay before insurance carrier begins paying

Question 6

what is a explanation of benefits ?

Answer 6

statement from insurance that details what was paid , denied, reduced in payment . also includes info about amnts applied to deductible, coinsurnace, and allowed amnts

Question 7

what is a participating provider ? (PAR)

Answer 7

prov who agree to write off the difference between the amount charged by prov and the approved fee established by the insurer