Insurance Terminology

Question 1

form provided to patient when provider believes Medicare will probably not pay for services

Answer 1

Advance beneficiary notice (ABN)

Question 2

max amount a third-part payer will pay for service

Answer 2

Allowed amount

Question 3

amount that is paid at the time of service

Answer 3

Copayment

Question 4

policy provision frequently found in medical insurance where the policyholder and insurance company share cost of covered losses in a specified ration (i.e. 80:20)

Answer 4

Coinsurance

Question 5

specific amount a patient must pay out of pocket before insurance begins paying

Answer 5

Deductible

Question 6

statement from insurance detailing what was paid/denied/or reduced in payment. also contains info about amounts applied to deductible/coinsurance/allowed amounts

Answer 6

Explanation of benefits

Question 7

providers who agree to write off difference between amount charged by provider and approved fee from insurance

Answer 7

Participating provider (PAR)