Common Insurance Terms

Common Insurance Terms You Should Know

  • Bill/invoice/statement:The summary of your financial responsibility after insurance has processed your claim.
  • Claim:The form that the physician files with a health insurance company that details the services and procedures performed by the physician, on your behalf, and other pertinent data that is required by the health insurance company to receive payment.
  • Deductible:The amount you must pay for medical treatment before your health insurance company starts to pay.
  • Co-Insurance:The part of your bill, often in addition to your co-pay, that you must pay. It is usually a percentage of the total medical bill.
  • Co-payment “Co-pay”:The part of your medical bill you must pay each time you visit the physician. This is a pre-set fee determined by your health insurance policy.
  • In-Network:The physician has a contract with the health insurance company to provide you with medical care.
  • Out-of-Network:The physician is not contracted with the health insurance company to provide you with medical care.
  • Pre-admission approval or certification number:This is a number authorizing the health insurance company to pay benefits for your care. You may need to obtain this number before you see the physician in order for the health insurance company to pay.
  • Primary health insurance company:The health insurance company that is responsible to pay your benefits first when you have more than one health insurance plans.
  • Secondary health insurance company:The secondary health insurance company is not the first payer of your claims. The remaining claim balance will be sent to a secondary health insurance company, if provided, after payment is received from the primary health insurance company.
  • Explanation of Benefits (EOB):A document that your health insurance company sends to covered individuals explaining what medical treatment and/or services were paid for on your behalf .
  • Coordination of Benefits (COB):A group policy provision that helps determine the primary carrier in situations where an insured is covered by more than one policy. This provision prevents an insured from receiving claims overpayment.