Health Care Claims Consulting
Simplifying Complexity
HCCC believes in education. The more you know about the terminology and the process, the more involved you can become in helping yourself.
In order for you to get a handle on some of the terms we use most often, here is a sample list for you to look up. Consider it homework. We do this for a reason.
It is truly our goal to never have to work with you. If we can help you by making you learn, then when you seek us out you really do have a problem and need help.
Some of these terms were on the home page. The terms below are in no particular order because they will occur in no particular order in a conversation with your provider, your insurer, etc.
Now that you are looking at this and feeling overwhelmed, fear not, we have defined the terms in simple words. Just send an email to jdwolfe@healthcareclaimsconsulting.com and we will send you the definitions for these and more. When you do request the definitions, feel free to mention a word or phrase that you may have heard but do not know see here. That helps us as well to expand our list. Well, enjoy!
Co-Pay
Adjudication
U.C.R.
R.V.S.
I.C.D.
Allowable Charges
Deductible, Annual
Deductible, Per-Occurrence
Deductible, Family
Cost-Sharing (Co-Insurance)
Annual Out-Of-Pocket (Stop-Loss)
Preferred Provider
Primary Provider
Gatekeeper
Carry-Over
Pre-existing Conditions Clause
Waiting Period
Out of Network
HIPAA
COBRA, Federal
COBRA,
Qualifying Event
Open Enrollment
UB 82
Rating
Not Covered
Prescriptions, Brand Name
Prescriptions, Formulary
Prescriptions, Generic
Experimental Procedures
Reimbursement Rate
Closed Panel Provider
Medical Group (for HMO’s)
