At Children's Hospital Colorado, we realize families are not always familiar with the billing and medical terminology we use. Below is a list of commonly used billing terms and their definitions to help guide you through the process.
Common billing terms
Billing statement - A summary of patient account activity that is sent to parents or guardians updating them regarding the status of a claim
Claim - Information billed to the insurance company for services provided to your child
Contractual write-off/adjustment - The difference between the insurance contracted amount and the amount of the charge
Co-payment (patient responsibility) - The fee per visit paid by the patient or family for healthcare services as determined by your medical insurance policy
Co-insurance (patient responsibility) - The portion (in percent) paid by the patient or family for health-care services as determined by your medical insurance policy
Colorado Indigent Care Program (CICP) - The Colorado Indigent Care Program (CICP) provides funding to clinics and hospitals so that medical services can be provided at a discount to Colorado residents that meet the eligibility requirements for the CICP. However, the CICP is not a health insurance program. Visit the CICP website to learn more.
Deductible (patient responsibility) - The amount that the patient or family must pay for healthcare services before the insurance policy begins making payments. The health insurance policy sets this amount; usually it is due every calendar year.
Demographics - Patient/guarantor/subscriber legal name, gender, birth date, address, phone number and employer information
Explanation of Benefits (EOB) - 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 legal guardian of the patient
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
Referring physician - The physician who referred the patient to the attending provider, or referred the patient to the facility for testing
Payment arrangements - A formal payment plan set up when the balance due cannot be entirely paid by the due date
Payor - A third-party entity (commercial or government) that pays medical claims
Primary care physician (PCP - The provider who provides well and sick care for the patient
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.
Remittance mailing address - The address to send payment for goods or services received
Subscriber - The person who holds and/or is responsible for the medical insurance policy
Need help with a medical term?
Need help understanding the medical terminology on your billing statement? Search Conditions We Treat on our website or visit MedlinePlus, the medical dictionary from the U.S. National Library of Medicine and the National Institutes of Health.