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Health Insurance Glossary


If you or someone you know is seeking substance abuse rehabilitation, it is important to understand the different classifications and categories that insurance companies use to discuss addiction treatment. Whether the term is intensive inpatient treatment or detoxification level of care, you can find it here. The more you understand health insurance terms, the better your ability to make the right decision involving addiction treatment. If you have additional questions, not found on this page please call us at 866.812.8231.
Below you will find a comprehensive Health Insurance Glossary:

A

Admissions Consent and Acknowledgement
An agreement that provides facilities with the right to treat a patient and the patient’s acknowledgement that he or she is agreeing to treatment.

AMA
When a patient leaves treatment Against Medical Advice , meaning the physician has not yet released the patient from his/her care.

Assignment of Benefits
The patient agrees to have to insurance company pay the treatment provider directly.

B

Benefits

Each insurance plan provides its subscribers with different benefits. These are the services covered under a specific plan. All plans are different.

C

Certificate of Credible Coverage

Documentation from the insurance company that serves as proof of patient coverage.

Certification

Patient has been approved for services.

Co-Insurance

The pre-determined cost shared by the patient and the insurance company. This is generally given as a percentage.

CPT Code

Current procedural terminology code used to define what procedure was performed.

D

Death Certificate

Official court document showing the deceased’s name and other identifying information.

Debt Acknowledgement and Payment Agreement

Patient signs this document that indicates how much the co-pay and deductible will be and what the monthly payments will cost.

Deductible

Fee that patient will be responsible for prior to any insurance payment.

Detoxification Level of Care

This is the first phase of addiction treatment provided by medical staff that must occur before treatment can begin. It is also known as detox .

Discharge Summary Plan

A written plan for the client that summarizes the treatment and the aftercare plan for each patient.

Durable power of attorney

A legal document that provides a party other than the patient to represent the patient’s best interest with regard to treatment, payment, Cobra, appeals, etc.

F

Financial Agreement

Document advising patient of financial responsibility.

H

HCFA 1500

A doctor’s claim form used to submit a bill.

I

Inpatient Hospital

A licensed and insured facility managed by doctors and nurses who oversee patient care in the early phases of addiction treatment. These facilities do not have operating rooms or perform surgical procedures.

Intensive Inpatient Treatment

Provides patients with 24 hour medical monitoring, clinical services by an interdisciplinary team, a specified number of group and individual counseling hours, non-verbal therapies to help patients express themselves, medication compliance and more.

Intensive Outpatient Program (IOP) Level Care

No room or board is provided for patients. Services are comprised of structured programs, typically three hours, three days per week. IOP is typically not a substitute for inpatient treatment.

L

Level of Care Determination

The assessment and placement of a patient in the proper phase of addiction treatment.

License

Certificate issued by the state that authorizes a doctor to practice medicine, a nurse to practice, a facility to provide addiction treatment etc. There many different types of licenses.

N

No Cert Policy

Services can be provided without insurance certification and authorization.

Non-Assignable Insurance Benefits

This is a letter to the subscribing in which patient indicates that should insurance not pay the provider, the insurance check sent to the subscriber and immediately signed over to the facility.

O

Out of Pocket Maximum

The maximum amount a subscriber will have to pay out his or her pocket.

P

Partial Hospitalization Program (PHP) Level of Care

A partial hospital/day treatment program that has specific hour requirements per day, typically five days per week. PHP is usually not a substitute for inpatient treatment services.

Plan Documents

Official documents that show all eligible and non-eligible services are called plan documents or certificates of coverage.

Pre-Existing Form

The pre-existing form is completed to ensure that a subscriber does not have a condition that existed prior to the effective date of the current policy that would exclude its coverage under the plan.

Private Pay

This occurs when a patient uses their own financial resources to directly pay for treatment.

R

Rehabilitation (intensive inpatient) Level of Care

An early phase of treatment with a planned regimen of evaluation, observation, medical monitoring, and clinical protocols delivered by an interdisciplinary team that occurs in a twenty-four hour monitored setting.

Residential Level of Care

Residential treatment is a level of care that provides clients with living facilities and treatment services. There may be a nurse who is on call, but not on site, and a physician who will periodically provide medical visits.

S

Self Pay

Treatment is paid for entirely by the patient. This is synonymous with private pay.

Student Verification

This verification determines the full time or part time status of a student. It is obtained through the schools Registrar’s office.

U

Utilization Review

Healthcare professionals who help determine the level of care, placement and necessary medical services.