Boosting Medical Literacy

Much of the confusion around medical billing stems from the technical terminology being used by medical care providers and insurance companies. In an effort to educate consumers, TAFEC defines some of the more common terms below:

  • Coinsurance: the specified percentage of the claim amount that is allowed but not paid by the carrier.
  • Copay: the amount required to be paid to a provider by or on behalf of a patient in connection with services rendered.
  • Covered services: services that are specified under the terms of the patient’s benefit coverage.
  • Deductible: the specified amount paid annually by the patient before they can receive insurance benefits.
  • In-network: covered services provided to patients by a provider who is contracted with a particular health plan.
  • Out-of-network: covered services provided to patients by a provider who is not contracted in a particular payer’s network.
  • Preauthorization: approval must be obtained from the insurance company prior to receiving a medical service or procedure.

For more medical billing terms, take a look at the Texas Department of Insurance’s Glossary of Common Insurance Terms.