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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 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.
^ In Delaware, MedExpress is referred to as MedExpress Walk-In Care.
Urgent Care MSO, LLC ("MSO") is a management services company which provides management services on behalf of Private Office Practices operating urgent and walk-in care centers under the name "MedExpress". The Private Office Practice has complete authority with regards to all medical decision-making and patient care. MSO shall, in no way, determine or set the methods, standards, or conduct of the practice of medicine or healthcare provided at, by, or through any Private Office Practice, or by any of its professionals. MSO provides consultation services and offers recommendations through its Chief Medical Officer for the Private Office Practice to consider, reject, revise and/or adopt as it deems fit.