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 company.
• 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 co-insurance amounts).
• 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 Specialist visit.
• 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 amount.
• 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.