Cost sharing in health insurance refers to the portion of healthcare costs that policyholders are responsible for paying out of their own pockets. It is a way to distribute the financial burden of healthcare expenses between the insurance company and the insured individual. Cost sharing typically includes various types of payments, such as deductibles, copayments, […]
Articles Tagged: insurance
What is EOB in medical billing?
An Explanation of Benefits (EOB) is a document provided by an insurance company to the policyholder and the healthcare provider, detailing the outcome of a medical claim. It serves as a summary of how the insurance company processed the claim, the amounts billed, the amounts covered, and any remaining balances or patient responsibilities. Here’s what […]
What is Coordination of Benefits (COB) in Medical Billing?
Coordination of Benefits (COB) is a process used in medical billing to determine the primary and secondary insurance coverage for an individual who has multiple health insurance plans. When a person is covered by more than one insurance plan, COB ensures that the total benefits paid by all the plans do not exceed the actual […]
What is Prior authorization?
Prior authorization, also known as pre-authorization or pre-certification, is a process in medical billing and insurance where healthcare providers obtain approval from an insurance company or payer before performing certain procedures, tests, treatments, or prescribing specific medications. It is a requirement for the payer to review and approve the medical necessity and appropriateness of the […]