Insurance Terminology Flashcards
Advance Beneficiary Notice (ABN)
A form provided to the patient when the provider believes Medicare will probably not pay for services received.
Allowed amount
The maximum amount a third-party payer will pay for a particular procedure or service
Copayment
An amount of money that is paid at the time of medical service
Coinsurance
A policy provision frequently found in medical insurance whereby the policyholder and the insurance company share the cost of covered losses in a specified ratio, such as 80:20
Deductible
A specific amount of money a patient must pay out of pocket before the insurance carrier begins paying.
Explanation of Benefits
A statement from the insurance carrier detailing what was paid, denied, or reduced in payment; also contains information about amounts applied to the deductible, Coinsurance, and allowed amounts
Participating provider (PAR)
Providers who agree to write off the difference between the amount charged by the provider and the approved fee established by the insurer.
