Term
|
Definition
| studies that an insurance company use. |
|
|
Term
|
Definition
| insurance that would reimburse the employer when losses exceed a specific amount agreed on by the employer and the reinsurance carrier. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| an item covered by an insurance policy, or something paid to on behalf of a recipient. |
|
|
Term
|
Definition
| buying insurance or coverage for the purpose of making a profit. |
|
|
Term
|
Definition
| any amounts which the patient pays toward their deductible in the last three months of the year will carry over and will be applied towards the next year's deductible. |
|
|
Term
|
Definition
| any amounts paid towards the deductible by any member of the family will be added up to reach the deductible. |
|
|
Term
|
Definition
| limit that stipulates that if the coinsurance portion of a patient's bill reaches a certain amount, all subsequent claims will be paid 100% of the allowed amount. |
|
|
Term
|
Definition
| person who receives payment on a claim, often the person who receives benefit in the case of a deceased member. |
|
|
Term
|
Definition
| insurance carrier has an obligation to pay a benefit under the contract, but has a subrogated right for a portion of the recovery that the claimant may obtain from a third party. |
|
|
Term
|
Definition
| does not take into consideration the benefits of the old plan, but only that the former plan was medical and the new plan is medical coverage. |
|
|
Term
|
Definition
| the dollar amount determined for a specific service type or a particular geopraphic area in which the provider practices. |
|
|
Term
|
Definition
| preapproval for admission on an elective, nonemergency hospitalization. |
|
|
Term
|
Definition
| estimate of maximum benefits that may be paid under the plan for the services. |
|
|
Term
|
Definition
| determines whether the estimated lentgh of time and scope of the inpatient stay is justified by the diagnosis and symptoms. |
|
|
Term
|
Definition
| surgery that is recommended as an elective procedure when an alternative method of treatment may be preferable for a number of reasons. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| surgical puncture of the cul-de-sac for removal of fluid. |
|
|
Term
|
Definition
| hernia of the bladder that protrudes into the vagina. |
|
|
Term
|
Definition
| condition in which endometrial tissue occurs in various sites in the abdominal or pelvic cavity. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| incision into the uterus. AKA cesarean section. |
|
|
Term
|
Definition
| small device that is placed within the uterus to prevent pregnancy. |
|
|
Term
|
Definition
| surgical excision of an ovary. |
|
|
Term
|
Definition
| condition in which there is a lack of one or both testes. |
|
|
Term
|
Definition
| process of artificially placing semen into the vagina so that conception can take place. |
|
|
Term
|
Definition
| condition in which the semen lacks spermatozoa. |
|
|
Term
|
Definition
| inflammation of the glans penis. |
|
|
Term
|
Definition
| benign prostatic hyperplasia/enlargement of the prostate gland. |
|
|
Term
|
Definition
| to remove the testicles in a man or ovaries in a women. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| surgical excision of a testicle. |
|
|
Term
|
Definition
| narrowing of the opening of the prepuce wherein the foreskin cannot be drawn back over the glans penis. |
|
|
Term
|
Definition
| inflammation of the prostate |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| prostate-specific antigen |
|
|
Term
|
Definition
| transurethral resection of the prostate. |
|
|
Term
| common accident provision |
|
Definition
| provision whereby only one deductible is taken for all the members of a family involved in the same accident. |
|
|
Term
|
Definition
| allowable amount for that particular procedure assigned according to the particular CPT code. |
|
|
Term
|
Definition
| files which are kept in batches or groups based on the date they were and the person who prcessed them. |
|
|
Term
|
Definition
| files for holding claims and other processing information. |
|
|
Term
|
Definition
| adjustment that completely reverses a claim payment. |
|
|
Term
|
Definition
| states that the plan covering the male employee is primary, and the plan covering the female employee is secondary. |
|
|
Term
|
Definition
| COB applied to both medical and dental charges combined. All savings are kept intermingled. |
|
|
Term
| partial credit adjustment |
|
Definition
| adjustment that partially reverses a claim payment. |
|
|
Term
|
Definition
| are designed to compensate an insured for all of the actual losses or damages to make that person whole again. |
|
|
