Billing Statement

Summary of patient account activity that is sent to patients or guarantors updating them regarding the status of their claim.

Claim

The information billed to the insurance company for services provided.

Co-insurance

A percentage of allowable charges for which you are responsible as determined by your medical insurance policy.

Co-payment

A set fee for a particular service as determined by your medical insurance policy

Deductible

The amount that the patient or family must pay for health-care services before the insurance policy begins making payments. The health insurance policy sets this amount; usually it is due every calendar year.

EOB (Explanation of Benefits)

A detailed explanation of coverage from the insurance company for the medical services provided.

Financial Assistance

Adjustments made for qualified responsible parties, based on financial assistance applications and established financial guidelines.

Guarantor

The individual responsible for payment of the bill.

Managed Care

A medical delivery system that manages the quality and cost of medical services.

Medicaid

The joint federal / state program that provides health care insurance to low-income families.

Out-of-Pocket Maximum

An out-of-pocket maximum is a cap on how much you have to pay for your family's covered medical expenses in a calendar year. After you reach the out-of-pocket maximum, the plan pays 100% of all remaining covered expenses for that year.

Prior Authorization / Precertification

A formal approval obtained from the insurance company prior to delivery of medical services. Many insurance companies require prior authorization or precertification for specific medical services.

Subscriber

The person who holds and / or is responsible for the medical insurance policy.