Home
Services
Physicians
Locations
Insurance Payers
Recruitment
News
Frequently Asked
Answers to some Frequently Asked Billing Questions
Definitions of uncommon terms, commonly used in the medical field:
Co-Pays or Co-Insurance: Amount designated by the insurance company as the responsibility of the insured (patient). A co-pay is usually a dollar amount, while co-insurance is usually a percentage of the total bill that is the patient’s responsibility.
Coordination of Benefits (COB) Rules: When a patient is covered by more than one insurance company, these regulations determine which insurance is to be billed first (primary) for services. State and Federal guidelines apply.
Deductible: Amount designated by the insurance company as the patient's responsibility, reported as an amount that must be paid before insurance benefits begin.
Explanation of Benefits (EOB): Itemized statement from your insurance company detailing which services are covered.
Medicare - Part A: Medicare hospital insurance covers care in the hospital, at any skilled nursing facility and from a home health agency. For more information on Medicare, visit http://www.medicare.gov/
Medicare - Part B: Medicare supplementary insurance covers outpatient services from hospitals, physicians, surgeons or any professional technicians. For more information on Medicare, visit http://www.medicare.gov/
Medicare – Part D: Medicare insurance that pays for prescription medications except for those given/prescribed while in the hospital. If the medication is given while in the hospital, it is covered under Medicare Part A. This coverage has unique aspects, and recipients must be enrolled in qualifying plans to take advantage of this coverage. For more information on this coverage, please visit the following link: http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/
Pre-certification: Pre-certification is the authorization of medical services by your insurance company. Typically your physician will pre-certify your procedure or visit. However, in most cases, you are ultimately responsible. If pre-certification is not performed, your insurance company may reduce your level of benefits or deny benefits altogether.