Glossary of Billing and Medical Terms
At Cincinnati Children's Hospital Medical Center, we realize families of 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 Terms
- BCMH
- Bureau of Children with Medical Handicaps is a secondary insurance for Ohio children with chronic, long-term medical needs.
- Billing Statement
- Summary of patient account activity that is sent to parents or guardians updating them regarding the status of their claim.
- CHIP
- Children's Health Insurance Program. This is a federal program that provides health insurance for children up to age 19. Eligibility is based on income and family size.
- Claim
- The information billed to the insurance company for services provided to your child.
- 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 or family for health-care services as determined by your medical insurance policy.
- Deductible
- The amount that the patient or family 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 your child.
- 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.
- Hamilton County Tax Levy
- The Hamilton County Health and Hospitalization Levy provides free or reduced-cost health care to qualifying Hamilton County residents at Cincinnati Children's.
- HCAP
- The Hospital Care Assurance Program is Ohio's version of the federally required disproportionate share hospital program. It provides additional payments to hospitals which provide a disproportionate share of uncompensated services to the indigent and uninsured.
- 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.
Medical Terms
Need help with a medical term on your billing statement? Search our health topics or use MedlinePlus, the medical dictionary from the U. S. National Library of Medicine and the National Institutes of Health.
