INSURANCE TERMS

Question 1

private insurance

Answer 1

provided by persons employer

Question 2

Primary Insurance

Answer 2

insurance that’s filed first and is the main insurance for a person

Question 3

premium

Answer 3

the amount of money that a person pays for their insurance

Question 4

secondary insurance

Answer 4

durable coverage, can pay unpaid balances

Question 5

birthday rule

Answer 5

the plan of the parent with the first birthday in the calendar year is the primary insurance

Question 6

self insured

Answer 6

individual pays for their insurance (usually self-employed

Question 7

Self-Pay

Answer 7

people who have no coverage

Question 8

government plans

Answer 8

special programs by state and federal government that provides insurance for the elderly, indigent, and children

Question 9

co pay

Answer 9

a specified sum of money based on the pt insurance policy benefits use at the time of service

Question 10

deductible

Answer 10

specific amount of money a pt must pay out of pocked before insurance carrier begins paying for services

Question 11

EOB

Answer 11

proved to the pt by insurance company as a statement (bank statement)

Question 12

Co-insurance

Answer 12

percentage of the total cost that an individual must contribute toward each service (90%,10%,80%,20%)

Question 13

RA

Answer 13

an EOB sent to the provider from insurance carrier (contains multiple pt and providers)

Question 14

ABN

Answer 14

form that a Medicare pt will sign whenthe provider thinks medicare wont pay for specific service/item

Question 15

medicare

Answer 15

pt 65 and older for part a (hospitalization) part b (routine office visits), part d (prescription coverage)

Question 16

tricare

Answer 16

authorizes dependents of military personnel to see civilian practictioners

Question 17

CHAMPVA

Answer 17

covers surviving spouses and depended children of veteranswho died in service-related disabilities

Question 18

Medicaid

Answer 18

health insurance to the medically indigent population through a cost sharing program between federal government and states (children and child baring age)

Question 19

Workers compensation

Answer 19

a lesislative law that protects employees against the cost of medical care resulting from work related injury

Question 20

CHIP

Answer 20

offers low cost health coverage for children from birth through age 19. designed for families who make too much to qualify for Medicare but cannot afford private health coverage

Question 21

government plans

Answer 21

medicare, Medicaid, tricare, CHAMPVA

Question 22

group policies

Answer 22

offered through individuals employer who will usually pay a portion of premium from employees pay

Question 23

individual policies

Answer 23

insurance plans that an individual funds themselves

Question 24

HMO

Answer 24

type of insurance plan that limits coverage of care from doctors who work for or contract with the HMO (referral needed)

Question 25

PPO

Answer 25

medical care arrangement in which medical professionals and facilities provide services to subscribed at reduced rates

Question 26

HSA

Answer 26

savings account that can be used to pay for medical expenses

Question 27

FSA

Answer 27

funded with pretax dollars, does not roll over onto the next year funds(funds lost if not used)

Question 28

ICD-10-CM

Answer 28

allows more specific reporting of diseases and newly recognized conditions allows for specificity and laterality of coding for payment

Question 29

CMS-1500

Answer 29

claim form that is sent to the insurance company for review and payment

Question 30

referrals

Answer 30

document or form required by insurance companies that is used when a provider wants to send a pt to a specialist

Question 31

participating provider

Answer 31

the provider and the insurance company have agreed between the amounts charged and approved and what will and will not be reimbursed

Question 32

account balance

Answer 32

total amount owed on an account

Question 33

debt

Answer 33

an amount owed

Question 34

accounts recievable

Answer 34

moneu owed to the provider

Question 35

accounts payable

Answer 35

debts incurred and not yet paid

Question 36

credit

Answer 36

monetary balance in an individuals favor

Question 37

assets

Answer 37

entire saleable property of a person, association, corporation or estate applicable or subject to the payment

Question 38

Liabilities

Answer 38

amounts owed; debt