Health Insurance Insights: Plans, Processes, and Prior Authorization-Health Insurance Insights Glossary and References

Health Insurance Insights Glossary and References

Pdf Summary

The document provides an extensive glossary of insurance terminology and related references, focusing largely on health insurance concepts. It covers various terms crucial for understanding healthcare policies and procedures, including types of insurance plans, financial responsibilities, and medical billing processes.<br /><br />Key terms include **ABN (Advance Beneficiary Notice)**, which is a form given to patients forewarning them of possibly non-covered Medicare services, along with the options to manage their financial responsibilities for such services. **Coinsurance** and **Copay** refer to patient financial responsibilities, expressed as a percentage and a specific dollar amount respectively, while the **Deductible** specifies the cost a patient must pay annually before insurance coverage begins.<br /><br />**Authorization** is crucial as it determines if a service is medically necessary. Different insurance plans like **EPO (Exclusive Provider Organization)**, **HMO (Health Maintenance Organization)**, **PPO (Preferred Provider Organization)**, and **POS (Point of Service)** have distinctive networking and referral requirements, influencing how medical services are accessed and financed.<br /><br />**CPT (Current Procedural Terminology)** and **ICD (International Classification of Diseases)** are used for coding medical procedures and diagnoses. **Formulary** refers to the list of approved medications under an insurance plan, impacting prescription costs.<br /><br />The document also explains **Medigap** as supplemental insurance for Medicare, outlines **Public vs. Private Insurance**, and describes government programs like **Medicaid**, **Medicare**, **TRICARE**, and **VA (Veterans Affairs)**. The **No Surprises Act** ensures transparency in billing to avoid unexpected charges.<br /><br />Other terms, such as **Verification**, **Referral**, and **Out-of-pocket** expenses, aid in understanding the full spectrum of healthcare operations. Additionally, the document briefly touches on non-health insurance like **Automobile Insurance** and **Worker's Compensation**.<br /><br />Each term is linked to online resources, facilitating further exploration and understanding of these insurance concepts.

Keywords

insurance glossary

health insurance

ABN

Coinsurance

Copay

Deductible

EPO

HMO

CPT

Medigap