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Common Billing & Insurance Terms
Explanation of Benefits (EOB): A statement an
insured member receives from an insurance company that lists the
services provided at MedExpress, the amount billed, any insurance
payments, and patient responsibility.
Co-Pay: A specified dollar amount that is
determined by a patient's insurance company, and paid out-of-pocket
toward a specified service at the timeof service.
Deductible: A specified financial amount that
an insured member must pay toward medical services before the
insurance company will make any payments.
Guarantor: Someone, who may or may not be the
patient, who either accepts or is legally responsible for the
payment of bills for medical services.
Patient Responsibility / Financial
Responsibility: The amount of a medical bill that patients
are required to pay.
Insured Member / Subscriber / Beneficiary:
Someone who has medical coverage through a health insurance
In-Network: When a doctor, hospital, or other
healthcare provider is part of an insurance plan's network, the
provider agrees to accept your insurance payment for covered
services as payment in full (minus your deductibles, co-pays, and
Out-of-Network: When a doctor, hospital, or
other healthcare provider is not part of an insurance plan's
network, it is considered a Non-Participating or Out-of-Network
Provider. If a patient receives medical services from an
Out-of-Network Provider, the patient may be responsible for higher
costs or the payment in full (for all services rendered).
Specialist: A medical provider that
specializes in treating certain parts of the body or certain
medical conditions. Because MedExpress specializes in providing
Urgent Care treatment, some insurance companies consider it a
Statement Balance: The amount that a doctor,
hospital, or other healthcare provider charges a patient after the
patient's insurance company, or Medicare has paid its approved
Co-Insurance: The portion of the balance for
covered medical expenses that an insured member must pay after
payment of the deductible.
Pre-authorization: The process of obtaining
permission to perform a service from the insurance carrier before
the service is performed.