计费术语表
汽车保险 - 保险 billed due to an auto accident or a theft
坏账 - A person or persons whose account that has been sent to a collection agency for further action
余额明细表 - A statement that shows a balance on an account which has not been paid
受益覆盖 - 服务 provided to plan members as described by insurance policy
索赔 - A demand for payment in accordance with an insurance policy
共同保险 - The percentage of treatment cost for which the consumer is responsible on an insurance claim
付费/费用 - The fixed dollar amount the consumer must pay for each visit to a doctor’s office
可扣除的 - The annual amount the consumer must pay for medical services (excluding premiums) before the insurance plan begins covering costs
除外责任 - Medical services not covered by an insurance policy
服务费 - A plan in which the insurance company and consumer share the cost of treatment according to a fixed ratio. (For example, the company might pay 80 percent, while the consumer pays 20 percent in co-insurance)
规定的 - A list of medications covered by an insurance plan
高免赔额健康计划 - A plan that offers lower monthly premiums but much higher deductibles (often more than $2,个人5万美元,000 for families) than typical managed-care plans
健康维护组织 -健康维护组织, 或组织, offers insurance plans in which the consumer pays a modest co-payment for doctor and hospital visits, but coverage is restricted to participating doctors. Specialist care requires a referral from a primary care provider
健康储蓄账户 - A tax-free, portable savings account that is used to pay medical expenses. Unused funds can be carried over from year to year. Requires enrollment in a high-deductible health plan (HDHP).
网内 - A term that refers to the fact that a doctor or hospital is part of the group (network) whose services are covered by an insurance plan at the maximum rate
保险公司 - A financial institution that sells insurance
被保险人 - A person or persons who is a policyholder of an insurance policy. Also known as the subscriber, policyholder, cardholder, beneficiary or consumer
医疗补助计划 - A federal and state-funded program that pays for medical care for those who cannot afford it
医疗保险 - A federal program that helps pay for medical care for people age 65 and older, 或者有残疾的人. Those enrolled are responsible for premiums, deductibles and co-payments
补充性医疗保险 - Private insurance used to fill gaps in 医疗保险 coverage
网外 - A term that refers to the fact that a doctor or hospital is not part of the group (network) whose services are covered by an insurance plan at the maximum rate
门诊 - A patient who is admitted to a hospital or clinic for treatment that does not require an overnight stay.
初级保健医师 - A doctor chosen by a patient in a managed-care plan to provide routine care, as well as referrals to medical specialists
POS / Point-of-service计划 -选项, 也称为服务点计划, offered with certain health maintenance organizations (HMOs) allowing for some coverage for out-of-network treatment. Consumer often can visit specialists without a referral from a primary-care physician
PPO/首选供应商组织 - An insurance plan in which the consumer pays a co-payment for visits to in-network doctors. PPOs partially cover treatment by out-of-network doctors
人身伤害 - When a person has suffered some form of injury, 生理上或心理上的, 是一场事故的结果
计划 - A program or policy stipulating a service or benefit
政策 - A written contract or certificate of insurance
预先授权 - An insurance plan requirement that you or your primary doctor need to notify the insurance in advance of certain medical procedures or inpatient stays
预先存在的条件 - A medical condition not covered by an insurer because the consumer is believed to have had the condition prior to obtaining the policy
溢价 - A fee paid by the consumer for participation in a health plan
处方 -书面命令, 尤其是医生, for the preparation and administration of a medicine or other treatment.
推荐 - The recommendation of a medical professional
二次索赔 - A request for payment after a primary insurance has processed a claim
自付 - Uninsured patient who has no third party insurance coverage
止损 - The point at which a consumer has fully paid the deductible and reached the maximum amount of co-payment required by an insurance policy. 保险 covers 100 percent of additional costs for the remainder of the year
工人的补偿 - Payments required by law to be made to an employee who is injured or disabled in connection with work