Health Insurance Terminology 2

A request for your health insurer or health plan to review a decision or a grievance again

• Appeal

• Authorization

• Coordination of Benefits (COB)

• Grievance

A complaint that an individual communicates to his or her health insurer or plan

• Broker

• Authorization

• Appeal

• Grievance

The process by which medical care or a specific service is approved by a healthcare reimbursement source

• Evidence of Coverage (EOC)

• Authorization

• Accreditation

• Explanation of Benefits (EOB)

A description, sent to patients by the health plan, of benefits received and services for which a healthcare provider has requested payment

• Certificate of Insurance (COI)

• Balance Billing

• Explanation of Benefits (EOB)

• Evidence of Coverage (EOC)

The legal document describing a subscriber's coverage under a health plan such as a Health Maintenance Organization (HMO)

• Formulary

• Evidence of Coverage (EOC)

• Premium

• Explanation of Benefits (EOB)