| B |
| Balance
billing |
Top |
The
practice of billing a patient for the fee amount
remaining after insurer payment and co-payment
has been made. |
| Base
year costs |
Top |
In
Medicare, the amount a hospital actually spent
to render care in a previous period. Depending
on the hospital's Medicare cost reporting
period, the base year was the fiscal year ending
on or after September 30, 1982 and before
September 30, 1983 for hospitals in operation at
that time. |
| Basic
Benefits |
Top |
A
set of "basic health services"
specified in the member's certificate and those
services required under applicable federal and
state laws and regulations. |
| Beneficiary
(Also eligible; enrollee; member) |
Top |
Any
person eligible as either a subscriber or a
dependent for a managed care services in
accordance with a contract. |
| Benefit
Limitations |
Top |
Any
provision, other than an exclusion, which
restricts coverage in the Evidence of Coverage,
regardless of medical necessity. |
| Benefit
Package |
Top |
The
list of covered services an insurance
company/HMO/PPO offers to a group or individual.
The list of covered services an insurance
company/HMO/PPO offers to a group or individual. |
| Benefit
Payment Schedule |
Top |
List
of amounts an insurance plan will pay for
covered health care services. |
| Benefits |
Top |
Benefits
are specific areas of Plan coverage's, i.e.,
outpatient visits, hospitalization and so forth,
that make up the range of medical services that
a payer markets to its subscribers. Also, a
contractual agreement specified in an Evidence
of Coverage, determining covered services
provided by insurers to members. |
| Board
Certified (Boarded, Diplomat) |
Top |
Describes
a physician who has passed a written and oral
examination given by a medical specialty board
and who has been certified as a specialist in
that area. |
| Board
Eligible |
Top |
Describes
a physician who is eligible to take the
specialty board examination by virtue of being
graduated from an approved medical school,
completing a specific type and length of
training, and practicing for a specified amount
of time. Some HMOs and other health facilities
accept board eligibility as equivalent to board
certification, significant in that many managed
care companies restrict referrals to physicians
without certification.
|
