| Term | Definition |
|---|---|
| Certificate of Coverage |
the legal description given employees or beneficiaries about the
benefits, providers, and general rules and regulations of their health
plan
|
| Choice |
Choice
as it pertains to health insurance, an open selection of multiple medical professionals and facilities for health services |
| Claims |
bills for services individuals receive from physicians, hospitals,
laboratories,and other providers that are sent to the individual's
insurance company
|
| Clinician |
a health care professional that is directly involved with patient care,
such as practicing physicians versus administrators or researchers
|
| Co-insurance |
co-insurance refers to the amount an individual is required to pay for
services, after a deductible has been paid, often specified by a
percentage of the total; for example, the employee pays 20% toward the
charges for a service and the employer or ins
|
| COBRA |
the Consolidated Omnibus Budget Reconciliation Act of 1985 requires
group insurance plans of more than 20 employees to continue to offer
health insurance to patients for 18 months after leaving their job; if
a patient opts for this coverage, they must
|
| Coordination of Benefits |
agreement between health plans and insurers to make certain the same
services are not paid for more than once by several different plans
when a patient has insurance from more than one source
|
| Copayment |
the copayment is the predetermined fee that an individual pays each
time for health care services or prescriptions, in addition to what the
insurance covers, that is usually expressed as a specific dollar
amount, such as $15 or $50 depending on what th
|
| Coverage |
means that a person has private insurance through their employer or as
an individual, or public insurance with Medicaid or Medicare, or other
public programs; coverage stems from the meaning that a person's health
care costs will be paid either by
|
| CPT Code |
an industry standard used for coding and billing which helps determine
the costs of specific services and procedures; CPT stands for
physician's current procedural terminology
|
| Credentialing |
the review process on health care providers to examine their license,
certification, evidence of malpractice insurance and history; includes
information given by the provider as well as by other organizations and
individuals
|
| Deductible |
the specified amount of money an individual or member must pay before
insurance benefits begin; deductibles are usually expressed in terms of
an annual amount rather than on a per incident basis
|
| Denial of claim |
refusal by an insurance company to pay a claim submitted to them on behalf of an insured individual by a health care provider
|
| Diagnostic test |
an examination or procedure used to determine a person's particular
illness, disease or condition, such as a urine test for pregnancy
|
| Discharge planning |
evaluation of patients' medical needs in order to arrange for appropriate care after discharge from an inpatient setting
|