appeal
Medical term Administrative Assisting
A request that the health plan review a decision denying a benefit or payment.
Related terms
- allowed amountThe maximum a plan will pay for a covered service; also called the eligible expense or negotiated rate.
- balance billingA provider billing the patient for the difference between its charge and the plan's allowed amount; network…
- birthday ruleA coordination-of-benefits rule: a child covered by both parents uses first the plan of the parent whose…
- charting by exceptionDocumenting only findings that differ from established normal standards.
- claimA request to a health plan for payment for services provided.
- coinsuranceThe patient's share of a covered service, figured as a percentage of the allowed amount.
- copaymentA fixed dollar amount the patient pays for a covered service, usually at the visit.
- deductibleThe amount the patient owes for covered services each coverage period before the plan starts to pay.
Study Administrative Assisting