The following terms may help you better understand your bill and the billing process.
This code enables you to login and create your own MyChart user account, along with user ID and password.
When your balance due has increased or decreased, both the insurance company and the hospital could adjust your balance.
The initial amount that a hospital gives to each service before a patient has the service.
A form submitted to the insurance company for payment.
A percentage of eligible expenses that you must pay. Co-insurance usually applies after you meet your deductible.
Coordination of Benefits
Determining which insurance company pays first if you are covered under more than one insurance plan.
When you pay a specific amount for a service, a copay is due at the time of service.
The amount a patient will pay after services have been completed and insurance has been applied to the amount.
Specific services or supplies that your insurance reimburses.
CPT stands for Current Procedural Terminology code. This is a 5-digit standard code for how medical professionals document and report medical services and procedures. Insurance companies use CPT codes to help determine reimbursement amounts for practitioners. Using CPT codes enables healthcare providers and insurance companies to communicate and track billing more efficiently.
The agreed amount of money your benefit plan requires you to pay first before they will pay. The deductible is usually an annual amount. After the deductible has been met, you will pay any eligible expenses for the rest of the year.
When an insurance company does not approve payment for a specific claim. In this case, the health insurer has decided not to pay for the procedure, test or prescription.
The person you carry on your insurance. Often this is a family member, such as a husband, wife or child.
The difference between total on the bill and the amount your insurance company covers.
A health plan ID number usually found on your insurance card.
The person responsible for paying the bill.
Health Insurance Exchange
The place to get insurance in Nevada if you currently do not have any.
A type of insurance plan that requires enrolled patients to receive their healthcare from a specific group of providers, barring some emergency care. If you go outside of the HMO’s network for non-emergency care, coverage for that care is impacted and may not apply.
ICD-10 stands for International Classification of Diseases, 10th Revision. ICD codes classify diagnoses and health issues of patients using four to seven digit alphanumeric codes, which denote signs, symptoms, diseases, conditions, and injuries. Both CPT and ICD-10 codes must be provided to insurance companies for the provider to be reimbursed properly.
Doctors or hospitals participating in your health plan or insurance plan.
A person who has insurance.
A list of all items and services during your stay.
A type of insurance plan that required patients to see only providers that have a contract with the managed care company, barring exceptions such as emergency or urgent care when the patient is outside of the plan’s service area.
Health insurance for low or modest-income individuals.
Health insurance for individuals 65+ and persons with disabilities.
Services that are not covered by a patient’s insurance plan.
Out of Network
Doctors and hospitals NOT on the “preferred” list for your insurance plan. Depending on your insurance, you may have higher out of pocket costs when receiving care from an out of network doctor or hospital.
Out of Pocket Maximum
The maximum amount a person needs to pay themselves.
The amount the patient is expected to pay.
Pay by Phone Code:
This code enables you to use the automated phone payment system.
Another name for an insurance company.
Preferred Provider Organization. A healthcare plan that covers a larger amount of a patient’s healthcare. Unlike HMOs, PPOs do not restrict patients to only the providers within their network in order for costs to be covered.
Getting advance approval from your insurance company for your services.
The amount after services have been completed without insurance or additional discounts applied.
Primary Care Provider
Your doctor or provider who coordinates your care.
The insurance company with first responsibility for paying eligible health expenses.
A healthcare professional (doctor or nurse practitioner) or facility (such as a hospital or clinic).
The insurance company with second responsibility for paying eligible health expenses.
Secure Health Code
This code is used to tie payments received to a specific guarantor account.
The person who purchased the insurance.
The unique number assigned to each visit.