Glossary

B

Billing a member or other responsible party for the difference between the insurer's payment and the actual charge.

The provision of mental health and substance abuse services.

Services available to a member as defined in the contract. Benefit design includes the types of benefits offered, limits (e.g. number of visits, percentage paid or dollar maximums applied), and subscriber responsibility (cost sharing components).

When the maximum number of visits for a specific service is reached, further benefits will not be considered.

The amount charged by a provider for a specific service.

The address to which a billing statement will be sent.

A process by which a physician who has been tested for proficiency in a medical specialty or subspecialty, by a medical specialty board, has passed those tests and therefore been certified as proficient in that medical specialty.

Denoting a physician who has completed the educational requirements necessary for eligibility to take the specialty board examinations.

A prescription drug that has been patented and is only available through one manufacturer.