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Module 1: Basic Insurance Terminology

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Covers basic medical insurance terminology used in billing

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Module 1: Basic Insurance TerminologyVersión en línea

Covers basic medical insurance terminology used in billing

por Dena Stone
1

Set amount the insured pays for medical costs before the insurance plan begins to pay for services

2

Typically a set dollar amount the insured is required to pay at the time of medical service

3

This cost sharing is usually a percentage of the total cost of care

4

An annual dollar threshold that, once met, the insurance plan covers services at 100% for the remainder of the plan year

5

A formal request from a PCP for a patient to have care with a specialty provider

6

A formal request for an insurance plan to apply benefits for services provided

7

A written, detailed description of how plan benefits were applied to a claim submission

8

An electronic version of an EOB

9

This type of insurance payment covers multiple claims from one payer

10

Refusal of an insurance company to honor a request to pay for healthcare services

11

Approval from a health plan for services to be provided

12

When two insurance plans work together to pay claims for a shared member

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