812.238.7000 for Union Hospital Terre Haute
765.832.1234 for Union Hospital Clinton

Union Health

(APC) Ambulatory Patient Classifications - a system for classifying outpatient services and procedures for purposes of payment. Call the Healthcare Financing Administration at 1-800-633-4227 to request a free brochure.

Assignment - a process under which Medicare pays its share of the allowed charge directly to the physician or supplier. Medicare will do this only if the physician accepts Medicare's allowed charge as payment in full.

Beneficiary - someone who is eligible for or receiving benefits under an insurance policy or plan. Beneficiary Liability - the amount beneficiaries must pay for covered services. These include co-payments, coinsurance, deductibles and balance billing amounts.

Certificate of Coverage (COC) - A description of the benefits included in a carrier's plan. The certificate of coverage is required by state laws and represents the coverage provided under the contract issued to the employer.

Community Service Care - Free or reduced-fee care provided due to financial situation of patients.

Children's Health Insurance Program (CHIP) - A federal program jointly funded by states and the federal government, which provides medical insurance coverage for children not covered by state Medicaid-funded programs.

Coding - How physician's services are identified and defined.

Co-insurance - a type of cost sharing where the beneficiary and insurance provider share payment of the approved charge for covered services in a specified ratio after payment of the deductible by the insured. For example, for Medicare physicians' services, the beneficiary pays co-insurance of 20 percent of allowed charges.

Consolidated Omnibus Budget Reconciliation Act (COBRA) - A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated. Applies to employers with 20 or more eligible employees. Typically, COBRA makes continued coverage available for up to 18 or 36 months. COBRA enrollees may be required to pay 100 percent of the premium, plus an additional 2 percent.

Coordinated Coverage - Integrating benefits payable under more than one health insurance (for example, Medicare and retiree health benefits). Coordinated coverage is typically arranged so the insured benefits from all sources not exceeding 100 percent of allowable medical expenses. Coordinated coverage may require beneficiaries to pay some deductible or co-insurance.

Coordination of Benefits (COB) - a provision that applies when a person is covered under more than one group medical program. (See "Coordinated Coverage" above.)

Co-payment - (1) A fixed dollar amount paid for a covered service by a beneficiary (See Co-insurance and Deductible). (2) Amount that a member of health plan has to pay for specific health services, such as visits to a physician. (See "Beneficiary Liability" and Co-insurance" above.)

Date Of Service (DOS) - the date(s) healthcare services were provided to the beneficiary.

Deductible - (1) The amount the patient pays for medical care before insurance covers the balance. (2) A type of cost sharing where the beneficiary pays a specified amount of approved charges for covered medical services before the insurer will pay for all or part of the remaining covered services. (3) Total amount a member of a health plan has to pay for services before that person-s plan begins to cover the costs of care. (See "Beneficiary Liability" above.)

Diagnosis-Related Groups (DRG) - (1) A system of classifying patients on the basis of diagnosis for purposes of payment to hospitals. The DRG system classifies payments into groups based on the principal diagnosis, type of surgical procedure, presence or absence of complications, and other relevant indicators.

Duplicate Coverage Inquiry (DCI) - a request to an insurance company or group medical plan by another insurance company or medical plan to find out whether other coverage exists (see Coordinated Coverage).

Durable Medical Equipment (DME) - medical equipment which: can withstand repeated use; is not disposable; is used to serve a medical purpose; is generally not useful to a person in the absence of sickness or injury, and is appropriate for use in the home. Examples include hospital beds, wheelchairs and oxygen equipment.

Employee Retirement Income Security Act of 1974 (ERISA) - This law mandates reporting, disclosure of grievance and appeals requirements and financial standards for group life and health. Self-insured plans are regulated by this law. Enrollee - person who is covered by health insurance.