Glossary of Billing Terms
At The University of Toledo Medical Center, we realize patients are not always familiar with the terminology we use with reference to the billing process. This list of commonly-used billing terms and their definitions will help guide you through the process.
Advanced Beneficiary Notice (ABN) A form to be signed for any services not covered by Medicare, making the patient financially responsible.
Billing Statement Summary of patient account activity that is sent to parents or guardians updating them regarding the status of their claim.
Claim The information billed to the insurance company for services provided to you.
Contractual The difference between the insurance contracted amount and the amount of the charge.
Co-payment or Co-insurance The fee per visit paid by the patient for health-care services as determined by your medical insurance policy.
Deductible The amount that the patient must pay for health-care services before the insurance policy begins making payments. The health insurance policy sets this amount; usually it is due every calendar year.
EOB (Explanation of Benefits) A detailed explanation of coverage from the insurance company for the medical services provided to you.
Financial Assistance Adjustments made for qualified responsible parties, based on financial assistance applications and established financial guidelines.
Guarantor The parent or guardian responsible for paying the bill.
HCAP The Hospital Care Assurance Program is Ohio's version of the federally required disproportionate share hospital program. It provides additional payments to hospitals which provide a disproportionate share of uncompensated services to the indigent and uninsured.
Managed Care A medical delivery system that manages the quality and cost of medical services.
Medicaid The joint federal / state program that provides health care insurance to low-income families.
Medicare Secondary Payer (MSP) A federally mandated series of questions that Medicare patients will be asked prior to each visit.
Payment Arrangements A formal payment plan set up with a Financial Counselor or Patient Financial Services when the balance due cannot be entirely paid by the due date.
Payer A third party entity (commercial or government) that pays medical claims.
Prior Authorization / Pre-certification A formal approval obtained from the insurance company prior to delivery of medical services. Many insurance companies require prior authorization or pre-certification for specific medical services.
Subscriber The person who holds and / or is responsible for the medical insurance policy.