Glossary

The following terms may help clarify your health care financial information.

Co-payment: A specified dollar amount you pay when services are provided. Your
co-payment is determined by your insurance plan.

Explanation of Benefits (EOB): Your insurance company will provide you an Explanation of Benefits to explain how your claims were processed. Most EOBs show covered and non-covered services and will provide information regarding amounts applied towards deductibles, coinsurance, and out-of-pocket maximums.

Referral: An approval from your primary care doctor for you to see a physician specialist or receive certain services.

Health Maintenance Organization (HMO): A type of managed care plan that contracts with select physicians, hospitals, and other providers to provide care for enrollees. In an HMO, you usually must receive all of your care from the providers in the network for your services to be covered, or secure an approved referral to seek services out of the network. You are responsible for making sure the referral and the prior authorizations are in place before receiving services or payment for the service will be your responsibility.

Pre-Admission Certification/Prior Authorization: An approval from your heath plan that certain services provided by the hospital will be covered.