The transfer of the right payment of insurance benefits to be paid directly to the health care provider of service. Birthday Rule (COB):

The percent of your medical bill benefits you are expected to pay as determined by your health insurance carrier. Contractual adjustment:

A group policy provision which helps determine the primary carrier in instances where the patient is covered by more than one insurance policy. Co-payment:

The amount the insurance company assigns as patient liability prior to their calculation of the insurance payment amount. Explanation of Benefits (EOB):

The person financially responsible for paying out the patient’s medical bills. Health Maintenance Organization (HMO):

Insurance managed medical delivery system that manages the quality and cost of medical services. Medicare:

Most managed care insurance plans are contracted with a specific group of health care providers of service. If a patient requests health care outside this specific provider group with a provider not c [..]

Health care plans that allow the patient to direct his/her own healthcare. The patient can self-refer within the network of contracted providers. He will be responsible for deductible and normally a p [..]

Many insurance plans require members to choose or be assigned to a PCP, who is responsible for providing or authorizing all medical care for the patient. Prior Authorization/Pre-certification:

A physician’s medical order for consultations/services for the patient with a specialist.