Advanced Beneficiary Notice (ABN): If Medicare will not pay for a procedure or service, the physician or hospital will request you to review and sign an Advanced Beneficiary Notice. This notice will assist you in determining whether you wish to have the procedure or service performed and how you prefer to pay for it.
Benefit: The amount your plan will pay a physician, group or hospital, as stated in your policy, toward the cost of the service or procedure to be performed by the physician.
Claim: The form that the physician files with a health insurance company that details the services and procedures performed by the physician, on your behalf, and other pertinent data that is required by the health insurance company to receive payment.
Co-Payment or “co-pay”: The part of your medical bill you must pay each time you visit the doctor. This is a pre-set fee determined by your health insurance policy.
Co-Insurance: The part of your bill, in addition to the co-pay, that you must pay, Co-insurance is usually a percentage of the total medical bill — for example, 20 percent.
Deductible: The amount you must pay for medical treatment before your health insurance company starts to pay – for example, $500 per individual or $1 ,500 per family. In most cases, a new deductible must be satisfied each calendar year.
Non-Covered Charges: Costs for medical treatment that your health insurance company does not pay. You may wish to determine if your treatment is covered by your health insurance policy before you are billed for these charges by the doctor’s office.
Primary Health Insurance Company: The health insurance company that is responsible to pay your benefit first when you have more than one health insurance plan,
Secondary Health Insurance Company: The secondary health insurance company is not the first payer of your claims. The remaining claim balance will be sent to a secondary health insurance company, if provided, after payment is received by the primary health insurance company.