An Ambulatory Center is a free-standing entity that furnishes health care services. It is neither integrated with nor a department in a hospital. It provides medical center on an outpatient basis. Physically separate facilities on the campus of a hospital...

An Appeal is a request from you for your health insurer or administrator to review a decision that denies a benefit or payment (or pays a lower-than-expected amount toward the billed charge for a medical service or treatment).  An Appeal...

Balance Billing occurs when a provider sends you a bill for the difference between a provider’s charge for a covered service or treatment and the insurance company’s Allowed Amount. For example, if the provider’s charge is $100.00 and the allowed...

Coinsurance is your share of the costs for covered health care services. It is calculated as a percentage (for example, 20%) of the allowable amount for the service. You pay the coinsurance amount plus your plan deductible (if not already...

Your co-payment is a fixed dollar amount (for example, $30) that you must pay for a covered health care service when you visit a provider.  This amount is usually due at the time the service is provided – not billed...

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal law passed by Congress that, among other things, allows individuals to maintain health coverage following termination due to a qualifying event. The law applies both to insured employees...

Your deductible is a fixed dollar amount (for example, $500), which you must pay for health care service before your health insurance plan begins to pay.  If your deductible is $500, your plan will not pay anything until you have...

Durable Medical Equipment (DME) is equipment or supplies ordered by a health care provider for everyday or extended use. DME may include oxygen equipment, wheelchairs, and crutches as well as blood-testing strips for diabetics. Some health plans may require a...

An Emergency Medical Condition is an illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid severe harm.