Healthcare consumers need to know the basic healthcare terms to discuss any financial issue with healthcare providers. The following are the terms:
| Balance Bills | Balance billing is when a doctor bills you the difference between their charge and what your health insurance pays. |
| Billed charges | Billed charges mean the total charges billed by health care service providers. |
| Co-insurance | The amount (typically a percentage) you are obligated to pay for covered medical services after you’ve satisfied any co-payment or deductible required by your health insurance plan. |
| Co-payment | The set or fixed dollar amount you are required to pay each time a particular medical service is used. A co-payment for services may be $10 per visit. |
| Contractual adjustments | Contractual adjustments generally reduce the amount of the service charge, thus reducing the amount owed on the claim. |
| Deductible | The cumulative amount that you must pay annually before benefits will be paid by the insurance company. If the insurance policy indicates a “$250 deductible,” the insurance company pays as agreed after you pay the first $250. |
| Explanation of Benefits (EOB) | The statement you receive from the insurance company showing the services, amounts paid by the plan and total for which you are being billed. |
| health insurance denial | A health insurance denial happens when your health insurance company refuses to pay for something. If this happens after you’ve had the medical service and a claim has been submitted, it’s called a claim denial. |
| In Network | A group of medical providers that are contracted with a specific insurance company for highest payment levels. |
| Insurance Payments | The amount your insurance company has contractually agreed to pay for the service. |
| No Surprises Act | The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. |
| Out-of-network care | Healthcare rendered to a patient outside of the health insurance company’s network of preferred providers. In many cases, the health insurance company will not pay for these services. |
| Patient Balance | The amount the consumer owes the provider. |