Navigating your way through health insurance benefits can be a challenge. It is very important to understand the terminology especially when deciding which benefits will work for you and finding a plan that will best meet your needs.
This brief glossary will provide insight for some of the more common terms when dealing with health insurance.
co-insurance: in indemnity, the monetary amount to be paid by the patient, usually expressed as a percentage of charges.
co-payment: in managed care, the monetary amount to be paid by the patient, usually expressed in terms of dollars. consumer driven health care (CDHC): refers to health plans in which employees have personal health accounts such as a health savings account, medical savings accounts or flexible spending arrangement from which they pay medical expenses directly.
deductible: the portion of medical costs to be paid by the patient before insurance benefits begin, usually expressed in dollars.
denial: refusal by insurer to reimburse services that have been rendered; can be for various reasons.
eligibility: the process of determining whether a patient qualifies for benefits, based on factors such as enrollment date, pre-existing conditions, valid referrals, etc.
exclusions: services that are not covered by a plan.
flexible spending arrangements (FSAs): an account that allows employees to use pre-tax dollars to pay for qualified medical expenses during the year. FSAs are usually funded through voluntary salary reduction agreements with an employer.
gatekeeper: in managed care, it refers to the provider designated as one who directs an individual patient’s care. In practical terms, it is the one who refers patients to specialists and/or sub-specialists for care.
health maintenance organization (HMO): a form of managed care in which you receive your care from participating providers.
health savings account (HSA): a savings product that serves as an alternative to traditional health insurance. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.
managed care: a method of providing health care, in which the insurer and/or employer (policyholder) maintain some level of control over costs and utilization by various means. Typically refers to HMOs and PPOs.
member: a term used to describe a person who is enrolled in an insurance plan; the term is used most frequently in managed care.
open enrollment: a set time of year when you can enroll in health insurance or change from one plan to another without benefit of a qualifying evening.
out-of-pocket: money the patient’s pays toward the cost of health care services.
payer: the party who actually makes payment for services under the insurance coverage policy. In the majority of cases, the payer is the same as the insurer. But, as in the case of very large self-insured employers, the payer is a separate entity under contract to handle the administration of the insurance policy.
policyholder: purchaser of an insurance policy; in group health insurance, this is usually the employer who purchases policy coverage for its employees.
preferred provider organization (PPO): a form of managed care in which the member has more flexibility in choosing physicians and other providers. The member can see both participating and non-participating providers. There is a greater out-of-pocket expense if member sees non-participating providers.
premium: the cost of an insurance plan shared by employer and employee.
provider: one who delivers health care services within the scope of a professional license.
reimbursement: refers to the payment by the patient (first-party) or insurer (third-party), to the health care provider, for services rendered.
Overall a very positive experience. The staff has been very professional and have provided me with not just therapy, but a method to continue my work outside the center. All the exercises provided have been such that they can be integrated into my normal workout routine. This should allow me to work on any problems on my own in the future. I have been very pleased with the progress I made and with the program.
Very professional and kind people who answered each question I had throughout the Low Back Program
I almost didn’t come back after the first week of therapy because the pain was so bad but I’m so glad I did. My experience was so good with all of the therapy assistants. I felt they were very caring.
I was really pleased with the service at AthletePlus. The staff is professional and helpful. I felt comfortable asking any questions about the therapy and anything related to my injury. I felt at ease getting advice on how to adapt the routines so I could do them at home. Overall, I would recommend them to anyone.
Excellent…no problems….they worked with me on scheduling which was very important to me
Very enjoyable. Instruction was concise and focus on my injury was expertly addressed. Chris let me describe in detail my injury and built a program specific to treating my issue.
Extremely helpful in helping my recovery from my injury. They were able to provide a program that helped me progress as smooth and quick as possible.
it was good. everyone was very nice and helped me a lot with my ankles. thinks guys, I am feeling great!
My experience here was amazing! I had great service and a speedy recovery thanks to AthletePlus!
Great. Open late so I didn’t have to work a lot of work. Physical Therapist were easy to work with and very friendly.