Some more imedical insurance terms

AMBULATORY SURGERY-Surgery done in the doctor's office or at a surgical center, and not requiring an overnight stay.

CARVE-OUT POLICY-A contracted agreement between an insurance company and another company which provides special services to its members, such as prescription drugs or cancer treatment.

CLAIM-A record of medical services provided to a patient and submitted by the provider to the insurance company for payment.

CPT-4-A 5-digit code that applies to medical services.

FEE SCHEDULE-A listing of the maximum fee which a health plan will pay for services based on CPT billing codes.

ICD-9-A 3 to 5-digit number code describing a diagnosis or medical procedure.

INPATIENT-A patient who is admitted to a hospital and receives medical services from a physician during at least a 24-hour period.

OUTPATIENT-A patient who receives health care services, but not admitted to a hospital during a 24-hour period.

PRIMARY CARE PHYSICIAN-A physician, usually a general, family practitioner or internist, who delivers general health care, and is most often the first doctor a patient sees. This physician treats the patient directly, refers them to a specialist(or secondary care physician) or admits them to the hospital.

SUBSCRIBER-A person who enrolls in a health care plan and agrees to pay for premiums , co-payments and deductibles that are part of the plan.

TREATING PHYSICIAN-A physician who provides care to the patient while in the hospital,an usually works a the hospital or comes in as a specialist.