The Strange Language of Health Care Terms Glossary of healthcare terms from the US federal government. ASO (Administrative Services Only) Managed care plans Primary care physician (PCP) Coinsurance Managed care provisions Reinsurance Copayment Maximum plan dollar limit Self-insured plan Deductible Maximum out-of-pocket expense Stop-loss coverage Flexible spending accounts or arrangements (FSA) Medical savings accounts (MSA)…
Category: Health Insurance
Pre Certification
Pre-certification, also known as prior authorization, is a process that insurance companies use to determine if a medical service or treatment is medically necessary before it is provided. This is typically required for elective or non-emergency procedures that are expected to be expensive or require a hospital stay. How Pre-Certification Works To obtain pre-certification, the…
Denied Claims
When we invest in health care insurance, we expect that our medical expenses will be covered. However, there are instances when our claims are denied, leaving us to pay for the costs out of our own pockets. Here are some of the top reasons for health care insurance claims being denied: Top Reasons for Denial…
Consumer Driven Health Plans
A Consumer Driven Health Plan, CDHP, is a type of health insurance plan that gives consumers more control over their healthcare expenses. It typically combines a high deductible health plan (HDHP) with a healthcare savings account (HSA) or healthcare reimbursement arrangement (HRA). Unlike traditional health insurance plans, where the insurance company pays for most or…
COBRA and ERISA
Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, is a law passed by the U.S. Congress, that mandates an insurance program giving some employees the ability to continue health insurance coverage after leaving the job, even if you quit or are fired. COBRA includes amendments to the Employee Retirement Income Security Act of 1974…