Common Insurance Terms
Insurance is a contract between you and an insurance company that protects you from financial losses. Hunterdon Health medically codes procedures based on Current Procedural Terminology (CPT®) codes. CPT® codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency. The CPT terminology is used across the country to report medical, surgical, radiology, laboratory, anesthesiology, genomic sequencing, evaluation, and management services under public and private health insurance programs.
The terms used when referring to health insurance can be confusing. This list of common terms was created as a resource for patients as they navigate their commercial insurance plan.
The paperwork you submit to the insurance company for services covered under your policy.
The portion of the cost of covered services that you pay after the deductible.
A flat fee you pay each time you visit a doctor or fill a prescription. This information is usually located on the back of your insurance card. If you do not see this, you should consult your plan for this information.
The amount of money you pay each year before your insurance company pays its share. For example, if your deductible is $5,000, you will need to pay $5,000 before your insurance will start to pay on your claims.
EOB stands for Explanation of Benefits. It is a document sent by your health insurance company after a claim is processed. An EOB will tell you:
The services or treatments received
The provider who billed for the services
The amount billed by the provider
The amount your insurance company paid
The amount you are responsible for paying (e.g., copay, deductible)
The EOB is not a bill, but it helps you understand how your health insurance is processing your claims and what your financial obligations may be.
The amount of money you pay to the insurance company for health insurance.
The most you pay per year for covered healthcare services.
Health Maintenance Organization (HMO): A network of hospitals, doctors, and other health services that work together to manage care and keep costs down.
Preferred Provider Organization (PPO): A health plan that contracts with a network of medical providers.