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Billing Term Glossary

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Approved Amount - The amount of the charge that a payer will consider in calculating benefits. (Under Medicare, also called "Medicare Allowable Charge")


Co-insurance - The percent of the approved charge that you have to pay after you pay your plan's deductible.


Co-payment - A type of cost sharing whereby the insured person pays a specified flat amount per unit of service or unit of time (e.g., $10 per visit, $25 per inpatient hospital day), with the insurer paying the balance.


Deductible - The amount you must pay before your carrier begins to pay each benefit period or each benefit year.


Managed Care Plans - Managed care plans involve a group of doctors and hospitals who have agreed to provide care to beneficiaries in exchange for a fixed amount of money every month.


Medical Savings Account - A health plan option made up of two parts. One part is a HealthCare Insurance Policy with a high deductible. The other part is a special savings account, called a Health Savings Account (HAS) or Medical Savings Account (MSA).


Original Medicare Plan - The traditional pay-per-visit arrangement that covers Part A and Part B services.


Private Fee-for-Service Plan - A private insurance plan that accepts members.


Referral - Authorization from your primary care doctor to see a certain specialist or receive certain services.


Medicare Supplemental Insurance Policy - Many private insurance companies sell Medicare Supplemental Insurance policies that pay for additional noncovered services.


Urgent Care - Unexpected illness or injury that needs immediate medical attention, but is not life threatening.

 




 

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Edward Hospital & Health Services
801 S. Washington, Naperville, IL 60540 • (630) 527-3000

Naperville • Plainfield • Bolingbrook • Oswego • Woodridge
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