As you examine your health bill, you may notice that the terms, labels, and various titles are not only confusing, but overwhelming! Rest assured that in the case of health insurance confusion, you are not alone. Yet, by understanding the terminology that is used by most health insurance companies, you can easily navigate your way through a clearer understanding of your health insurance policy and claims.
Common Health Insurance Terms
Co- Payment – A co-payment is the amount of money that you must pay in order to receive a medical treatment / service. The co-pay is not covered by your insurance company.
Covered Expenses – While you must pay your co-pay, the insurance company will pay for all “covered expenses. Each health policy has its own list of covered and uncovered treatments. For example, some policies pay for chiropractic care, while others may not.
Deductible – A deductible is how much money you must pay (out of pocket) before the insurance company will begin to cover costs of treatment. For example, if seeing a psychologist, an insurance company may require that a patient pays a $1,000 deductible before the company begins to cover the costs of treatment.
Exclusions – Exclusions are specific treatments, circumstances, conditions, or diseases that the policy will not cover / not pay for treatment.
PPO – PPO stands for Preferred Provider Organization, which basically means that the insurance company covers more of the costs of treatment if a patient visits one of the “cooperating facilities.” While insurance will cover doctors out of their preferred organization, patients will be forced to pay a higher out-of-pocket cost.
Premium – A premium is the amount of money that your employer pays in order for you (as well as fellow employees) to receive health insurance coverage.
Provider – Any hospital, clinic, or institution that provides medical care. This also includes any person, such as a doctor or nurse, who provides medical care.
Also, in addition to understanding basic health insurance terms, be aware that some health insurance policies may challenge certain medical charges. Typically patients with challenged charges will receive a notification in the mail. The notification will explain the details of the challenged charges, as the notification will also inform patients how to refute / oppose any insurance challenges.
