Patient Billing : Glossary of Terms
United Health Services Hospitals makes every effort to assist you with your
billing questions. The following page provides a glossary of common billing
terms to help you understand your billing statement.
Account Number: A unique number that is assigned to you each time you
visit the hospital.
Adjustment: A portion of your hospital bill that is adjusted in
accordance with the contract between United Health Services Hospitals and your
insurance company.
Amount Not Covered: The biIl amount that the insurance company will not
pay. It may include deductibles, coinsurances, and charges for non-covered
services. For example, a non-covered charge could be food trays for visitors,
personal grooming supplies, take-home supplies, and private rooms.
Amount Payable by Plan: The amount your insurance plan pays or covers for
your treatment, less any deductibles, coinsurance, or charges for non-covered
services.
Benefit: The services that are covered under your insurance plan.
COBRA Insurance: Health insurance coverage that you can purchase when you
are no longer employed, or awaiting coverage from a new insurance plan to begin.
Coverage may be purchased for up to 18 months from your date of separation. It
is generally more expensive than insurance provided through the employer but
less expensive than insurance purchased as an individual policy.
Coinsurance: The percentage of coverage not covered under your insurance
benefits. For example, your policy may cover 80% of charges. Your
coinsurance/patient portion would be the remaining 20%.
Co-payment/Co-pay: A set fee established by the insurance company for a
specific type of visit. This amount is due from the responsible party. This
information can routinely be located on the insurance card and will be different
amounts according to the type of visit. For example, Emergency Room Visit - $50,
Inpatient Stay - $100, Physician Office Visit - $20. Further information can be
obtained by calling your insurance plan.
Date of Service (DOS ): The date(s) when you were provided healthcare
services. For an inpatient stay, the dates of service will be the date of your
admission through your discharge date. For outpatient services, the date of
service will be the date of your visit or the date tests are performed.
Deductible: An amount that must be met on an annual basis that is
established by the insurance company and your benefit plan. Call your insurance
company for the most up-to-date information regarding your deductible.
Explanation of Benefits (EOB): This is a notice you receive from your
insurance company after your claim for healthcare services has been processed.
It explains the amounts billed, paid, denied, discounted, not covered, and the
amount owed by the patient. The EOB may also communicate information needed by
the insured in order to process the claim.
Financial Assistance: Hospital program that qualifies individuals for
help with payment of hospital bills based on their financial need.
Guarantor: The person responsible for payment of the bill.
Health Insurance Portability and Accountability Act (HIPAA): Law enacted
in 1996 to establish standards for handling patients’ Protected Health
Information (PHI). These standards related to billing, privacy and security.
Health Maintenance Organization (HMO): An insurance plan that has
contracted with providers to provide healthcare services at a discounted rate.
These services will require prior pre-certification, authorization, and/or
referrals.
Managed Care: An insurance plan that has a contract agreement with
hospitals, physicians, and other healthcare providers.
Medicaid: A state administered, federal and state-funded insurance plan
for low-income families who have limited or no insurance.
Medicare: A health insurance program for people age 65 and older, some
people with disabilities under age 65, and people with end-stage renal disease (ESRD).
For questions concerning the Medicare program, call the Social Security
Administration toll-free at 1-800-772-1213, or call your local Social Security
office.
Medicare Part A (Hospital Insurance): Healthcare coverage for inpatient
stays at participating hospitals.
Medicare Part B (Medical Insurance): Healthcare coverage for doctors'
services, outpatient hospital care, and some other medical services that Part A
does not cover, such as the services of physical and occupational therapists,
and some home health care.
Medigap: Medicare Supplemental Insurance available by private insurance
companies that pays for some services not covered by Medicare A or B, including
deductible and coinsurance amounts.
New York State Surcharge (NYHCRA): Healthcare tax that may be added to your
balance after insurance based on insurance benefits. This is collected by the
provider and submitted to the state.
Non-Covered Services: Services not covered under the patient's insurance
plan. These charges are the patient's responsibility to pay.
Out-of-Network Provider/Non-Participating Provider: The provider is not
part of the insurance plan's network of contracted providers. Generally,
services at out-of-network providers are paid for at a lower rate by the
insurance plan and at a higher rate by you.
Out-of-Pocket Costs: The amount that you pay until your benefit coverage
reaches 100%.
Point-of-Service Plans: An insurance plan that allows you to choose
doctors and hospitals without first having to get a referral from your primary
care physician.
Pre-Authorization Number: Authorization given by a health plan for a
member to obtain services from a healthcare provider. This is commonly required
for hospital services.
Pre-Certification Number: A number obtained from your insurance company
by doctors and hospitals. This number will represent the agreement by the
insurance plan that the service has been approved. This is not a guarantee of
payment.
Preferred Provider Organizations (PPO): An insurance plan that has a
contract with providers to provide healthcare services at a discounted rate.
These services may require prior pre-certification, authorization, and/or
referrals.
Protected Health Information (PHI): Any information that can identify you
as an individual and your past, present or future physical or mental health
condition.
Referral: Approval or consent by a primary care doctor for a patient to
see a certain specialist or receive certain services.
Subscriber: The person responsible for payment of premiums or whose
employment is the basis for eligibility for a health plan membership.
Customer Service:
Binghamton General Hospital
Wilson Memorial Regional Medical Center
Billing Information Numbers:
