||Organizations such as Blue Shield plans or commercial insurance firms that are under contract to administer the Part B (outpatient services) portion of the Medicare program.
||Medical services that are separated from a contract and paid under a different arrangement.
||A notification to an insurance company from either a beneficiary or provider that states that a patient has received medical service and is requesting payment of benefits.
||A type of health plan in which covered persons are required to select a primary care physician from the plan’s participating providers. The patient is required to see the selected primary care physician for care and referrals to other health care providers within the plan.
||An abbreviation for The Center for Medicare and Medicaid Services.
||The percentage of covered hospital and medical expenses after subtraction of any deductible for which an individual is responsible. Under Medicare Part B, after the annual deductible has been met, Medicare will generally pay 80% of the approved charges for covered services and supplies; the remaining 20% is the coinsurance, which is the responsibility of the beneficiary.
|Coordination of Benefits (COB)
||A method of determining the primary payment source when an individual is covered under more than one group medical program. COB allows group plans to work together so that the total benefits do not exceed total charges or that there is no duplication of benefits.
||The fee per visit paid by the patient for health-care services as determined by your medical insurance policy. An example is the $10.00 co-pay for physician office visits.
||The maximum amount an insurance carrier will approve for payment for a particular service provided by a physician.