Patient Account Definitions
Admission Date: The date when the patient began receiving medical services.
Appeal: A process in which either the member, hospital or doctor disputes the final determination from your insurance company for payment or denial of payment for services rendered.
Assignment of Insurance Benefits: An agreement that is signed by the guarantor that allows the hospital to be paid directly by the insurance company.
Billing Date: The date when the bill was generated.
Claim: A bill that is submitted to the insurance company for reimbursement.
Claim Form: The form used to submit charges to the insurance company for reimbursement.
Claim Number: A number that is assigned by the insurance plan that is used to track a claim.
Co-insurance: A percentage of the total charges that the patient (guarantor) is responsible for paying.
Co-Payment: A fixed dollar amount that the patient (guarantor) must pay prior to specific medical services being rendered.
Contractual Adjustments (C/A): The portion of the bill that the hospital does not charge the patient (guarantor) for, as previously agreed upon between the hospital and insurance company.
Coordination of Benefits (COB): A practice used by insurance companies in order to bring about awareness and establish proper coordination of benefits for members who hold multiple insurance policies. Many insurers will not pay a claim without this information.
Covered Benefit: A medical or health related service(s) that is (are) a covered benefit per the member's insurance policy. These services are payable either wholly or partially, depending upon your benefit levels.
Deductible: A specific dollar amount that the patient (guarantor) must pay before the insurance company will begin paying.
Discharge Date: the date when the patient was discharged from the hospital or the last day in which medical services were rendered.
Estimated Insurance Due: The amount when the hospital anticipates the insurance company will pay for services rendered.
Explanation of Benefits (EOB): A document or statement that is created by your insurance company after a claim has been received and processed. This document explains how a claim is paid or will be paid and will identify what portion of the bill is your responsibility.
Guarantor: The person or individual who signs the All Children's Hospital consent and is responsible to pay for all charges for services ordered on behalf of the patient.
Itemized Bill: A bill provided to you from the Hospital that shows all charges associated with the care that the patient received. This bill indicates the specific charges that have been submitted to your insurance if insurance information was provided.
Medical Record Number: A unique identification number that is assigned to the patient.
Non-Covered Services: Medical services that are not covered or payable by your insurance company. The patient (guarantor) may be responsible for the associated charges.
Non-participating Provider: A provider who has not entered into an agreement with an insurance plan and, therefore, is not part of the insurance or health network.
Participating Provider: A physician or hospital that has come to an agreement with an insurance plan to accept the insurance payment as payment in full, less any patient responsibility such as deductible, co-insurance or co pays.
Patient Account Number: A number that is assigned to the patient in order to identify a specific account or date(s) of service.
Patient Accounts: The area of the hospital which handles the hospital billing and collection aspects of the patient's care.
Personal Financial Statement of Guarantor(s): A form that is completed by the guarantor that indicates the guarantor's income, number of persons in the household and total out-of-pocket hospital expenses over the last twelve months.
Prior Authorization: A number assigned by the insurance company which indicates approval for certain medical services or treatments to be rendered.
Professional Billing: The area of the hospital which handles the billing and collection aspects of the patient's care as it relates to the hospital-employed physicians.
Referral: Some insurance companies require a referral or approval from your primary care doctor before you can receive care from outside medical services.
Remittance Advice: An explanation from the insurance company that is sent to the hospital, usually accompanied by payment, after the claim has been processed.
Service Date: The date(s) when care was provided to the patient from the hospital or provider.