1
Approval from a health plan for services to be provided
2
An annual dollar threshold that, once met, the insurance plan covers services at 100% for the remainder of the plan year
3
This cost sharing is usually a percentage of the total cost of care
4
Typically a set dollar amount the insured is required to pay at the time of medical service
5
A formal request from a PCP for a patient to have care with a specialty provider
6
An electronic version of an EOB
7
Set amount the insured pays for medical costs before the insurance plan begins to pay for services
8
Refusal of an insurance company to honor a request to pay for healthcare services
9
A formal request for an insurance plan to apply benefits for services provided
10
This type of insurance payment covers multiple claims from one payer
11
A written, detailed description of how plan benefits were applied to a claim submission
12
When two insurance plans work together to pay claims for a shared member
