Glossary

Billing Department

Billing Statement

Summary of patient account activity that is sent to patients, parents or guardians updating them regarding the status of their claim or balance due.

Claim

The information billed to the insurance company for services provided to you or your dependent.

Contractual

The difference between the insurance contracted amount and the amount of the charge.

Co-payment or Co-insurance

The fee per visit paid by the patient or family for healthcare services as determined by your medical insurance policy.

Deductible

The amount that the patient or family must pay for healthcare services before the insurance policy begins making payments. The health insurance policy sets this amount; usually it is due every calendar year.

EOB (Explanation of Benefits)

A detailed explanation of coverage from the insurance company for the medical services provided to you or your dependent.

Guarantor

The parent or guardian responsible for paying the bill.

Managed Care

A medical delivery system that manages the quality and cost of medical services.

Medicaid

The joint federal / state program that provides health care insurance to low-income families.

Payment Arrangements

A formal payment plan set up with Customer Service when the balance due cannot be entirely paid by the due date.

Payor

A third party entity (commercial or government) that pays medical claims.

Prior Authorization / Precertification

A formal approval obtained from the insurance company prior to delivery of medical services. Many insurance companies require prior authorization or precertification for specific medical services.

Subscriber

The person who holds and/or is responsible for the medical insurance policy.