Health Insurance Jargon Spurs Widespread Confusion

With a language all its own and processes that mystify even veterans of its industry, health insurance is a problem among consumers of all ages.

“People are treating it more like care insurance: you don’t use it until something happens” Kathleen Call, a professor in the University of Minnesota’s School of Public Health, said to Kaiser Health News.

“You have an accident, then you use it. Otherwise you’re trying not to use it. And that’s not the way we want health insurance to be used.”

Make sure you understand how your insurance plan works so you feel confident when using it.

To assist with this, here are five of the most commonly searched words in the healthcare industry along with their definitions.

  1. Deductible – The amount a person owes for healthcare services before future covered benefits are paid. Note, copays and other out of pocket expenses are often not applied toward a deductible.
  2. Copay or Copayment – The fixed amount you pay for a covered healthcare service, typically paid on the date of the service.
  3. Coinsurance – Your share of the costs of a covered healthcare service, calculated as a percent of the allowed, or discounted, amount for the service.
  4. Coverage determination – The decision made by your primary insurance carrier whether a service is covered. Note, your secondary coverage will follow your primary plan’s determinations.
  5. Explanation of Benefits – A statement, either from your primary insurance carrier or from ClaimLinx, with details about what your plan covers, how much was paid, how much money, if any, is still owed and more.

Look for more details on health insurance jargon in the future or contact help@claimlinx.com with any specific questions.

What is an Accumulation Period?

An “Accumulation Period” is the period of time during which an insured person incurs eligible medical expenses toward the satisfaction of a deductible and out of pocket maximum.  Most plans typically run on a calendar year basis, meaning from January 1st through December 31st.

For more information or questions about your plan, email service@claimlinx.com or call 513.677.6262 or 1-800-858-1772.

What is Cost-sharing?

What is cost-sharing? Health care provider charges for which a patient is responsible under the terms of their health plan. Common forms of cost-sharing include deductibles, coinsurance, and co-payments. Balance-billed charges from out-of-network physicians are not considered cost-sharing.

ClaimLinx is committed to helping you navigate your way through healthcare reform with tools and information that are ACA compliant.

For more information or questions about your plan, email service@claimlinx.com or call 513.677.6262 or 1-800-858-1772.

What is a Co-payment?

What is a co-payment, and how does it affect my health insurance plan?

A co-payment is a specific charge that your health insurance plan may require that you pay for a specific medical service or supply, also referred to as a “co-pay.” For example, your health insurance plan may require a $15 co-payment for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.

ClaimLinx is committed to helping you navigate your way through healthcare reform with tools and information that are ACA compliant.

For more information or questions about your plan, email service@claimlinx.com or call 513.677.6262 or 1-800-858-1772.