Healthcare providers or facilities that do not have a contractual agreement with an individual’s insurance plan. Seeking services from these providers may result in additional costs.
A fixed amount that a patient pays for covered healthcare services at the time of service, typically required for both in-network and out-of-network care.
The amount an individual must pay for covered healthcare services before the insurance plan begins to contribute. This is separate from copayments.
The maximum amount an individual has to pay for covered healthcare services during a specific period, after which the insurance plan covers 100% of the costs.
When a healthcare provider bills a patient for the difference between the provider’s charge and the allowed amount covered by the insurance, often applicable with out-of-network services.
The maximum amount an insurance plan is willing to pay for a covered healthcare service, based on negotiated rates with in-network providers.
The average cost of a healthcare service in a specific geographic area, used by some insurance plans to determine the allowed amount for out-of-network services.
A list of healthcare providers, including doctors, hospitals, and clinics, that have agreed to provide services at negotiated rates with a specific insurance plan.
A statement from the insurance company explaining how a claim was processed, including details on what the insurance covered, what the patient owes, and any remaining balance.
A recommendation by a primary care physician for a patient to see a specialist or receive specific medical services.
The process of obtaining approval from an insurance company before receiving certain medical services, procedures, or medications.
Medical services required for the treatment of a medical condition that, if not treated immediately, could lead to serious harm or impairment, often covered by insurance regardless of network status.