Preparing for Your Visit: Patient Access Pre-Services

The percentage of the shared cost of a covered healthcare service. For example, your plan may require that you pay 20 percent, after your deductible is met. At the time of service, you pay co-insurance plus any deductible you owe.

Refers to the limit on the total amount your health plan requires you to pay in deductible and coinsurance in a year. When a health plan member reaches their out-of-pocket maximum, the member no longer pays coinsurance because the plan will begin to pay 100 percent of the medical expenses.

A doctor or physician does not have a contract with your health insurance plan provider. This can sometimes result in higher prices or will not cover care from out-of-network providers except in the event of an emergency.

Current Procedure Terminology codes are numbers assigned to medical services and procedures. The codes are part of a uniform system maintained by the American Medical Association and used by healthcare providers and insurance companies. CPT codes are utilized in several ways such as: on medical bills to identify the charge for each service and procedure billed by the provider to you and/or your health plan. You will need CPT codes to obtain price estimates of your service(s) and/or to identify if your service requires an authorization.

A surgery deemed not emergent or urgent, is considered elective

An employer funded group plan from which employers are reimbursed tax-free for qualified medical expenses, up to a certain amount per year. Your employer funds and owns the account and can also be referred to as health reimbursement arrangements.

An arrangement set up through your employment to pay for many of your out-of-pocket medical expenses with tax-free dollars. You decide how much of your pre-tax wages you’d like to take out of your paycheck and put into an FSA. There is a limit on the amount you can put into your FSA each year, but your employer may set a lower limit. Funds added to your FSA account may not roll over, however, to verify please reach out to your employer’s benefits department.

A medical savings account available to taxpayers who are enrolled in a high-deductible health plan. Funds contributed to the account are not subject to federal income tax at the time of the deposit. Unlike an FSA, funds roll over from year to year if the funds are not used.

The process of getting approval from your health plan before you have any health care related services performed.

Medical services that are not included in your health plan. If you receive non-covered services, your health plan will not reimburse for those services, therefore, your provider will bill you. For a list of services or questions regarding which services your health plan covers, you must contact your health plan directly.