Glossary of Terms  

The following is a glossary of billing and insurance terminology to help answer your questions.

A

Account — Your charges for a medical visit.

Account Number — Number you're given by your doctor or hospital for a medical visit.

Actual Charge — The amount of money a doctor or supplier charges for a certain medical service or supply. This amount is often more than the amount an insurance plan approves.

Adjustment — The portion of your bill that your doctor or hospital has agreed not to charge you.

Admission Date (Admit Date) — Date you were admitted for treatment.

Admission Hour — Hour when you were admitted for inpatient or outpatient care.

Admitting Diagnosis — Words that your doctor uses to describe your condition.

Advance Beneficiary Notice (ABN) — A notice the hospital or doctor gives you before you're treated, telling you that Medicare will not pay for some treatment or services. The notice is given to you so that you may decide whether to have the treatment and how to pay for it.

Advance Medical Directive — Written ahead of time, a healthcare advance directive is a written document that says how you want medical decisions to be made if you lose the ability to make decisions for yourself. A healthcare advance directive may include a Living Will and a Durable Power of Attorney for healthcare.

All-inclusive Rate — Payment covering all services during your hospital stay.

Ambulatory Payment Classifications (APC) — A Medicare payment system that classifies outpatient services so Medicare can pay all hospitals the same amount.

Ambulatory Care — All types of health services that do not require an overnight hospital stay.

Ambulatory Surgery — Outpatient surgery or surgery that does not require an overnight hospital stay.

Amount Charged — How much your doctor or hospital bills you.

Amount Paid — The dollar amount that you paid for your doctor or hospital visit.

Amount Not Covered — What your insurance company does not pay. It includes deductibles, co-insurances, and charges for non-covered services.

Amount Payable by Plan — How much your insurer pays for your treatment, minus any deductibles, co-insurance, or charges for non-covered services.

Ancillary Service — Services you need beyond room and board charges, such as laboratory tests, therapy, surgery and the like.

Anesthesia — Drugs given to you during surgery to eliminate or reduce surgical procedure pain.

Appeal — A process by which you, your doctor, or your hospital can object to your health plan when you disagree with the health plan's decision to not pay for your care.

Applied to Deductible — Portion of your bill, as defined by your insurance company, that you owe your doctor or hospital.

Assignment — An agreement you sign that allows your insurance to pay the doctor or hospital directly.

Assignment of Benefits — When insurance payments are sent directly to your doctor or hospital.

Attending Physician Name — The doctor who certifies that you need treatment and is responsible for your care.

Authorization Number — A number stating that your treatment has been approved by your insurance plan. Also called a Certification Number or Prior-Authorization Number.