a number indicating that your treatment has been approved by your insurance plan. Also called an authorization number, prior authorization number, or treatment authorization number.
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insurance linked to military service. champva shares the cost of certain medically necessary procedures and supplies with eligible beneficiaries. champva does not have a network of health care providers, so eligible members can visit most authorized providers.
your medical bill that is sent to an insurance company for payment.
a number assigned by your insurance company to an individual claim.
centers of medicare and medicaid (cms)
the federal agency that administers the medicare program. In addition, CMS works with states to run Medicaid programs.
clinical investigation, clinical trial, or research study (also see “experimental or investigational treatments”)
research conducted to evaluate the safety and/or efficacy of a treatment, diagnostic procedure, preventive measure, or similar medical intervention by testing the intervention on patients in a clinical setting. Participation in clinical research is voluntary. The informed consent form explains who will pay the costs for the services that are part of the clinical trial. each study is different, but in many cases insurance will pay for medically necessary services that are part of the research study. sometimes research services are paid for by the study. check with your insurance plan or study team to determine coverage.
cms 1500 form
the standard paper form used by health care professionals and providers to bill insurance companies.
cobra (consolidated omnibus budget reconciliation act)
A federal law that protects employees and their families in certain situations by allowing them to keep their existing health insurance for a specified period of time. Cobra provides certain former employees, retirees, spouses, ex-spouses, and dependent children the right to temporary continuation of health coverage at group rates. the individual must pay the cost of the premium to maintain their insurance plan, but the costs are often less expensive than individual health coverage.
cobra applies only under certain conditions, such as job loss, death, divorce or similar events. charges generally applies to group health plans offered by companies with more than 20 employees.
translate clinical information from your medical record into numbers (such as diagnosis and procedure codes) that insurance companies use to pay claims.
the amount you must pay after your insurance has paid its share, according to your benefits contract. In many health plans, patients must pay a portion of the allowed amount. for example, if the plan pays 70% of the allowed amount, the patient pays the remaining 30%. If your plan is a preferred provider organization (see “preferred provider organization [ppo]”) or other type of narrow-network product, your coinsurance costs may be lower if you use an in-network provider instead. the preferred plan. list of suppliers. call your insurance company for more information.
commercial insurance plan
Commercial health insurance is usually an employer-sponsored or privately purchased insurance plan. Business plans are not maintained or provided by any government-run program. commercial policies can be sold individually or as part of a group plan.
consent for treatment
an agreement you sign that gives you permission to receive medical services or treatment from doctors or hospitals.
a predetermined flat fee that you pay at the time of service. Copayment amounts vary by service and may vary by provider (in-network, out-of-network, or type of provider) you see. amounts may also vary based on the type of service you are receiving (for example, primary care versus specialty care). For prescriptions, copay amounts may vary depending on brand vs. generic drugs. call your insurance company for more information.
coordination of benefits
how insurance companies work together when you have more than one insurance plan. a patient may be covered by more than one commercial insurance plan, for example, through an employer, as well as the employer of their spouse, parent, or domestic partner. If you have more than one insurance plan, check with the secondary policy to find out how it covers any remaining expenses after your primary coverage has paid its share. (see “secondary insurance”)
services that your insurance company pays for in whole or in part.
the days that your insurance company pays in whole or in part.
cpt code (current procedural terminology)
a 5-digit numbering system that helps standardize billing for professional and outpatient centers. there is a cpt code for certain types of medical services. Using this code allows healthcare providers and insurance companies to communicate and track billing more efficiently.