Balance – The amount indicated on the notice/statement owed to the creditor listed.
Commercial Health Insurance – Private Insurance. A basic, traditional insurance policy.
Co-Payment – An amount established by the insurance company as the patient’s responsibility of billed fees.
Deductible – An amount determined by the insurance company to be paid on an annual basis before benefits are paid.
DOS – Date of Service.
EOB/EOMB – Explanation of Benefits/Explanation of Medicare Benefits. These are provided by the patient’s insurance plan detailing how benefits are processed and paid for the services rendered.
Health Insurance Claim Form/HCFA 1500 – Health claim form (red and white form) sent to the primary or secondary insurance carrier.
HMO – Health Maintenance Organization.
Non-Covered Service – A service not covered under the limits of the patient’s health-insurance contract. These amounts are the patient’s responsibility to pay.
PIF – All charges are paid in full.
PPO – Preferred Provider Organization.
Pre-Certification – Requirement of your insurance company to determine medical necessity for service rendered. Pre-certification does not guarantee benefits for payment.
Proof of Insurance – A valid insurance card including the address where claims are to be mailed.
Self-Pay Patient – A person who has no insurance or does not want the services rendered filed with his/her insurance company.
Usual and Customary – Predetermined allowable limits used by insurance carriers to limit the maximum amount they will pay on a given service as governed by their contract with the patient.
Waiver of Financial Liability Form – A form signed by the patient before certain services are rendered, notifying him/her that Medicare may not cover this service and the patient will be responsible for payment.