Terminology Flashcards
What is your job title?
Benefit Verification Specialist
What is a policy?
A contract between the payer and patient
What are two types of plan terms?
Calendar year and fiscal year
Define premium
The monthly amount the insurer or sponsor pays to health plan to purchase health coverage
Define deductible
AMount patient pays out before insurance covers its share
Define co-pay
Payment an insurer has to pay for service
define coinsurance
% of total cost insurer pays
define out of pocket
Most amount of $ you will have to pay before insurance kicks in in a plan year
Does the provider network status affect the patient benefits?
Yes
Can you explain the IN- Network Provider?
Providers that are contracted w/ the payer that provides a discounted rate to insurer
Explain the co-pay assistance?
helps patient with out-of-pocket cost
Explain the patient assistance program (PAP)
Program offers assistance with co-pays
Can you explain the difference between co-pay assistance program and patient assistance program?
Co-pay assistance program helps w/ out-of-pocket cost (doctor visit)
PAP – Assist w/ cost of injection
Define Max out of pocket
The $ limit to a patient annual expenditures in co-pays, deductibles, and coinsurance
