A “seal of approval” for health care facilities. Being accredited means that a facility has met certain quality standards. These standards are set by private, nationally recognized groups that check on the quality of care at health care facilities.
Timeframe within a policy period in which deductible and out-of-pocket amounts are calculated. For most health insurance policies, the accumulation period is a calendar year.
ADMINISTRATIVE SERVICES ONLY (ASO):
An arrangement in which an employer hires a third party to deliver employee benefit administrative services to the employer. These services typically include health claims processing and billing. The employer bears the risk for health care expenses under an ASO plan.
ADMITTING PHYSICIAN :
The doctor responsible for admitting you to a hospital or other inpatient health facility.
The right granted to a doctor to admit patients to a particular hospital.
The care or follow-up treatment needed by a patient who has recently undergone surgery, been involved in an accident or has experienced an illness requiring hospitalization.
AGENT OF RECORD:
The insurance agent recognized by a client to represent the client’s interests in doing business with an insurance company.
All types of health services that do not require an overnight hospital stay.
Services, other than those provided by a physician or hospital, which are related to a patient’s care, such as laboratory work, x-rays and anesthesia.
ANY WILLING PROVIDER LAWS:
Legislation that requires health care plans to accept into their PPO and HMO networks any provider willing to agree to the network’s terms and conditions.
Request made to a payer to reconsider a decision, such as a claim denial or denied prior authorization request. Most appeals must be submitted in writing within a specified period.
ASSIGNMENT OF BENEFITS:
When an insured person assign benefits, they sign a document allowing the hospital or doctor to collect health insurance benefits directly from the health insurance company. Otherwise, the insured person pays for the treatment and is later reimbursed by the health insurance company.