20 Health Insurance Terms to Learn
Does insurance confuse you? You’re certainly not alone. Even in the medical imaging world we find ourselves dealing with confusing terms all the time.
KETV, a news station based in Omaha, shared 20 health insurance terms that can help you take control of your coverage again. You can see the full definitions and slideshow here.
- Allowed Amount: Also known as “eligible expense”/”negotiated rate”/”payment allowance;” it means the maximum amount health services are based on/are covered by the insurance company
- Balance Billing: The provider’s bill that gets sent you to after the insurance company pays their portion
- Claim: The bill that gets submitted to your health insurance company
- Co-Insurance: The percent that you pay in addition to whatever deductible you have.
- Co-Pay: The amount you pay at the time of each healthcare visit.
- Deductible: The amount you pay before receiving your benefits. Basically, when the insurance company says, “We’ll pay anything over $500,” then you know $500 is your deductible.
- Donut Hole, Medicare Prescription Drug: The coverage gap that occurs after you spend a certain amount on covered drugs, and you have to pay out-of-pocket for your prescriptions for up to a year. After that year, the insurance company resumes helping you pay.
- Essential Health Benefits: The 10 categories that the insurance company must cover.
- Excluded Services: The services that your insurance doesn’t need to cover.
- Health Insurance Marketplace: A way for anyone to compare health insurance plans based on the filters they choose.
- Health Savings Accounts (HSA): “A medical savings account available to taxpayers who are enrolled in a high deductible health plan.”
- High Deductible Health Plan: A type of insurance plan that can be combined with a health savings account/reimbursement arrangement.
- In- and Out-of-Network: Healthcare offices either have a contract with the insurance company (In-) or they don’t (Out-)
- Lifetime Limit: “A cap on the total lifetime benefits you may get from your insurance company.”
- Out-of-Pocket Maximum: The absolute most you would pay throughout your policy before insurance takes over 100% of the allowed amount.
- Pre-Existing Condition: A health problem that you had before establishing your insurance coverage.
- Preferred Provider: “A provider who has a contract with your health insurer or plan to provide services to you at a discount.”
- Premiums: “The amount you must pay for your insurance plan.”
- Preventive Care: Regular healthcare like checkups, counseling, and screenings.
- UCR (Usual, Customary, and Reasonable): The cost of medical services relative to location.