Billing Terms Glossary

At National Dizzy & Balance Center, we realize patients are not always familiar with the terminology we use with reference to the billing process. This list of commonly-used billing terms and their definitions will help guide you through the process.

Billing Statement

Summary of patient account activity that is sent to patient regarding the status of their claim.

Claim

The information billed to the insurance company for services provided to the patient.

Contractual

The difference between the insurance contracted amount and the amount of the charge.

Co-payment or Co-insurance

The fee per visit paid by the patient for health-care services as determined by your medical insurance policy.

Deductible

The amount that the patient must pay for health-care services before the insurance policy begins making payments. The health insurance policy sets this amount; usually it is due every calendar year.

EOB (Explanation of Benefits)

A detailed explanation of coverage from the insurance company for the medical services provided to the patient.

Financial Assistance

Adjustments made for qualified responsible parties, based on financial assistance applications and established financial guidelines.

Guarantor

The parent or guardian responsible for paying the bill.

Managed Care

A medical delivery system that manages the quality and cost of medical services.

Medicaid

The joint federal / state program that provides health care insurance to low-income families.

Payment Arrangements

A formal payment plan set up with Customer Service when the balance due cannot be entirely paid by the due date.

Payor

A third party entity (commercial or government) that pays medical claims.

Prior Authorization / Precertification

A formal approval obtained from the insurance company prior to delivery of medical services. Many insurance companies require prior authorization or precertification for specific medical services.

Subscriber

The person who holds and / or is responsible for the medical insurance policy.