Balance
Balance is the amount owed indicated on the billing statement.
Balance billing
Balance billing is the practice of a provider billing you for all charges not paid by your insurance plan, even if those charges are above the plan's usual, customary and reasonable charges or are considered medically unnecessary.
Coinsurance
Coinsurance is a cost-sharing arrangement in insurance, where the policyholder is required to pay a percentage of covered expenses for a particular healthcare service, while the insurance company covers the remaining percentage.
Coordination of benefits (COB)
Coordination of benefits is an agreement between your insurers to prevent double payment for your care when more than one plan provides coverage. The agreement determines which insurer has primary responsibility for payment and which has secondary responsibility.
Copayment
Copayment is the portion of a claim or medical expense that you must pay out-of-pocket. Copayment usually is a fixed amount.
Cost share
Cost Share refers to the division of healthcare expenses between the insurance provider and the policyholder. Cost share generally includes deductibles, coinsurance, copayments or similar charges. It does not include premiums, balance billing amounts for non-network providers or the cost of non-covered services.
Covered charges
Covered charges are services that are typically covered under the terms of your contract with your insurance company. It is important to note that even though services may be covered charges, they are often subject to your deductible and coinsurance.
Deductible
A deductible is the portion of your healthcare expenses that you must pay out-of-pocket before your insurance applies and begins to contribute toward covered expenses.
DOS
DOS is an abbreviation for "date of service."
Explanation of benefits (EOB)
An explanation of benefits is a statement provided to an insured person noting how a claim was paid or why it wasn't covered.
Noncovered charges
Noncovered charges are services that are not a covered benefit under the provisions of your insurance plan. If your insurance does not cover a service, you are liable for the entire amount. This is specific to your insurance policy.
Noncovered services
Noncovered services are services not covered under the limits of the patient's health insurance contract. These amounts are the patient's responsibility to pay. Patients should direct questions about coverage to their health plans.