Please
call us for more detail regarding insurance and fees. Our staff will verify and
explain your benefits before treatment. Below is a list of a few of the many plans
we provide for:
Video - Understanding Insurance Coverage
We know that the health payment process can be complex and confusing. Here is an
excellent video that explains general concepts about insurance coverage.
Health Insurance Terms
Below, you will see a list of terms that pertain to insurance coverage and payment
for health services.
- Co-insurance: in indemnity, the monetary amount to be paid by the
patient, usually expressed as a percentage of charges.
- Co-payment: in managed care, the monetary amount to be paid by
the patient, usually expressed in terms of dollars.
- Consumer Driven Health Care (CDHC): refers to health plans in which
employees have personal health accounts such as a health savings account, medical
savings accounts or flexible spending arrangement from which they pay medical expenses
directly.
- Deductible: the portion of medical costs to be paid by the patient
before insurance benefits begin, usually expressed in dollars.
- Denial: refusal by insurer to reimburse services that have been
rendered; can be for various reasons.
- Eligibility: the process of determining whether a patient qualifies
for benefits, based on factors such as enrollment date, pre-existing conditions,
valid referrals, etc.
- Exclusions: services that are not covered by a plan.
- Flexible Spending Arrangements (FSAs): an account that allows employees
to use pre-tax dollars to pay for qualified medical expenses during the year. FSAs
are usually funded through voluntary salary reduction agreements with an employer.
- Gatekeeper: in managed care, it refers to the provider designated
as one who directs an individual patient's care. In practical terms, it is the one
who refers patients to specialists and/or sub-specialists for care.
- Health Maintenance Organization (HMO): a form of managed care in
which you receive your care from participating providers.
- Health Savings Account (HSA): a savings product that serves as
an alternative to traditional health insurance. HSAs enable you to pay for current
health expenses and save for future qualified medical and retiree health expenses
on a tax-free basis.
- Managed Care: a method of providing health care, in which the insurer
and/or employer (policyholder) maintain some level of control over costs and utilization
by various means. Typically refers to HMOs and PPOs.
- Member: a term used to describe a person who is enrolled in an
insurance plan; the term is used most frequently in managed care.
- Open Enrollment: a set time of year when you can enroll in health
insurance or change from one plan to another without benefit of a qualifying evening.
- Out-of-pocket: money the patient's pays toward the cost of health
care services.
- Payer: the party who actually makes payment for services under
the insurance coverage policy. In the majority of cases, the payer is the same as
the insurer. But, as in the case of very large self-insured employers, the payer
is a separate entity under contract to handle the administration of the insurance
policy.
- Policyholder: purchaser of an insurance policy; in group health
insurance, this is usually the employer who purchases policy coverage for its employees.
- Preferred Provider Organization (PPO): a form of managed care in
which the member has more flexibility in choosing physicians and other providers.
The member can see both participating and non-participating providers. There is
a greater out-of-pocket expense if member sees non-participating providers.
- Premium: the cost of an insurance plan shared by employer and employee.
- Provider: one who delivers health care services within the scope
of a professional license.
- Reimbursement: refers to the payment by the patient (first-party)
or insurer (third-party), to the health care provider, for services rendered.
Reference: www.apta.org