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Billing, Insurance and Financial Assistance Definitions

For your convenience, listed below are definitions for terms commonly used in billing, health insurance and the financial assistance application process:

The portion of your bill that has been written off in accordance with a billing agreement with your insurance company or as outlined in our Financial Assistance Policy.
A notice that we give Medicare patients before services are rendered, stating that Medicare will not pay for some treatments or services. This notice is given to help patients decide whether to have the treatment and how to pay for it.
This is a written statement describing a patient’s wishes about medical treatment if they lose the ability to make their own decisions. Health care advance directives may include a living will and a durable power of attorney for health care.
The amount your insurance pays for treatment. This amount will not include any deductibles, co-insurance, co-payments or charges for non-covered services.
This is the maximum amount of money you will be required to pay each year, including copays and co-insurance, before your insurance network begins covering all of your medical expenses.
Many health insurance companies require patients to obtain permission before receiving hospital treatment. This is called the approval, authorization or certification process. We recommend that you become thoroughly familiar with your insurance company’s authorization requirements to avoid incurring higher costs by failing to follow your insurance company’s protocols.
The amount of money charged to your account for a specific medical service or supply. This amount does not reflect any adjustments.
This portion of the hospital payment is the responsibility of the patient or their guarantor (the person legally responsible for paying the hospital bill). The amount is determined by the insurance policy after meeting a deductible, and is usually based on a percentage.
The fixed amount you or your guarantor must pay based on the types of medical services received. This payment is due when services are rendered. Your co-payment amounts may be listed on your insurance card.
The amount that your insurance plan dictates that you must pay before they will pay your claims. Your deductible amounts may be listed on your insurance card.
This term applies to patients who do not have insurance coverage. A deposit is the amount a self-paying patient is required to pay the hospital before elective and/or scheduled services are rendered.
Medical services, including examination and stabilization, provided to a patient who requires immediate attention as a result of experiencing acute symptoms, severe pain or the impending birth of a child.
An approximation based on the average cost associated with a specific medical procedure. However, since each patient’s medical needs are unique, the final cost may be less or more than the original estimate.
This is the notice you will receive from your insurance company after your hospitalization. It will inform you what was billed, the payment amount approved by your insurance company, the amount paid and any amount you are responsible for.
 
These are income thresholds used primarily to estimate the number of Americans in poverty each year. These guidelines are updated each year by the Census Bureau and are also used to determine who qualifies for federal subsidies or financial assistance.
 
Programs that Yuma Regional Medical Center offers to qualified patients who have limited financial resources.
 
This is the amount that you or your guarantor is responsible for paying.
 
This is the person legally responsible for paying a hospital bill. This person is usually the patient, but may also be the parent of a minor child (under age 18) who receives medical services.
 
This federal law sets standards for protecting the privacy and security of your health information.
 
A Health Maintenance Organization (HMO) is a network of doctors and hospitals you are allowed to see under the terms of your health insurance coverage. These healthcare providers are also referred to as being “in-network.” If you belong to an HMO and choose to see a doctor out-of-network, you may pay a higher co-payment.

With a Preferred Provider Organization (PPO), you can see any doctor you choose. All current Healthcare Marketplace Exchange programs are PPOs. We recommend that you check if your current physician is included in the PPO you’re considering before selecting that plan.
 
A household is composed of one or more people who occupy a housing unit. Not all households contain families. Under the U.S. Census Bureau definition, family households consist of two or more individuals who are related by birth, marriage or adoption, although they also may include other unrelated people. Nonfamily households consist of people who live alone or who share their residence with unrelated individuals.
 
This amount is determined on a before-tax basis and includes earnings, unemployment compensation, workers’ compensation, Social Security, Supplemental Security Income, public assistance, veterans’ payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household and other miscellaneous sources. If a person lives within a family household (see definition above), household income includes the income of all household members. Noncash benefits such as food stamps and housing subsidies do not count in this amount.
 
Your network includes all of the facilities, providers and suppliers your health insurance plan has contracted with to provide health care services.
 
Any asset that is cash or can be easily converted to cash such as checking and savings accounts, money markets, stocks, bonds or Certificates of Deposit (CDs).
 
As defined by Arizona’s Medicaid Program, Medically Necessary Care includes those services, based upon an assessment of the eligible individual’s medical needs, that are reasonable and required to identify, diagnose, treat, correct, cure, palliate or prevent a disease, illness, injury, disability or other medical condition, including pregnancy. By Medicaid guidelines, these services must be provided in the most appropriate location where they may be safely and effectively rendered and do not include care provided primarily for the convenience of the patient, their caregiver or healthcare provider or for cosmetic reasons.
 
This is the notice that Medicare patients receive following hospitalization. It lists what was billed, the amount Medicare paid and the amount due from the patient. It is also called an Explanation of Medicare Benefits.
 
If you have a health insurance provider, you are considered to be a member of that group.
 
If your insurance company is not contracted with Yuma Regional Medical Center, we will bill the insurance company as a courtesy to you. If full payment is not received within 45 days, you will be billed for the balance due.
 
A doctor or other health care provider who is not part of your insurance plan's network. Choosing one of these providers may result in higher out-of-pocket costs for you.
 
A written document that describes the financial assistance programs available at Yuma Regional Medical Center, including the eligibility requirements, how to apply and how to obtain more information, including copies of the Financial Assistance Policy (FAP) and application.
 
This is the amount that you pay to your insurance company or healthcare plan to receive healthcare and/or prescription drug coverage.
 
The insurance company first responsible for paying a patient’s claim.
 
This is simply another term for a healthcare facility (hospital or clinic) or caregiver (such as a physician or nurse practitioner) that provides you with medical care or treatment.
 
Designed to protect your privacy as a patient, form must be signed by you to give the billing office permission to discuss your account with the representative(s) you designate.Release of Information form must be signed by you to give the billing office permission to discuss your account with the representative(s) you designate.
 
As defined by Yuma Regional Medical Center, a resident is a person living primarily in Yuma County, LaPaz County, Bard, California or Winterhaven, California with the intention to remain living there. People who are not considered residents are individuals who come to Yuma Regional Medical Center to receive medical care and who maintain a primary residence outside of the counties and cities listed above.
 
Additional coverage that may pay charges not covered by your primary insurance. Payment will be made according to the terms of your policy and will be coordinated with your primary insurance.
 
An individual who has no level of insurance or third-party assistance with meeting his or her payment obligations.
 
An individual who is exposed to significant financial losses due to inadequate health insurance coverage. Underinsured patients have some level of insurance or third-party assistance, but still have out-of-pocket medical expenses that exceed his or her financial abilities.
 

If you have any questions about your bill, health insurance or financial assistance please call our Patient Financial Services department at 928-336-7030 and we will be glad to assist you.

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