Look up key words that may help you better understand the billing process.
- When your balance due has changed either up or down, 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 copays 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.
- 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.
- The person you carry on your insurance. Often this is 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.
- 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.
- 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.
Out of Pocket Maximum
- The maximum amount a person needs to pay themselves.
- The amount the patient is expected to pay.
- Getting advance approval from your insurance company for your services.
- The amount after services have been completed without insurance applied.
Primary Care Provider
- Your doctor 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.
- The person who purchased the insurance.
- The unique number assigned to each visit.