Patients & Families

Common Patient Financial Services Definitions 

Unsure about a term used on a financial application or bill? Check the Glossary below for definitions of commonly-used terms. 


Term

Definition

CHARGE

The dollar amount a provider sets for services rendered before negotiating any discounts.  The charge will most likely be different from amount paid.

COINSURANCE

The patient’s share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

COST

The amount paid for a service. It varies by the party incurring the expense – patient, provider, insurer, employer.

DEDUCTIBLE

The amount you owe for covered health care services before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve paid $1,000 for covered health care services subject to the deductible. The deductible may not apply to all services.

OUT-OF-POCKET PAYMENT, OR PATIENT LIABILITY

The portion of total payment for medical services for which the patient is responsible including copayments, coinsurance, and deductibles.  Other out of pocket includes amounts for services that are not covered in the patient’s benefit design.

PAYER

An entity that negotiates rates for provider services, collects revenue through premium payments, processes provider claims for service, and pays provider claims using collected premiums.

PRICE

The total amount a provider expects to be paid by payers and patients for health care services.

PRICE TRANSPARENCY

Readily available information on the price of health care services that, together with other information, helps define value and compare other providers .

PROVIDER

An entity or individual that furnishes a health care service

VALUE

The quality of health care service in relation to the total price paid for the service.