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Insurance Terms Defined

Being a doctor in a small office I’ve had the opportunity to work and learn numerous aspects of running things.  Insurance is the primary aspect I hear questions about on a daily basis.  It seems as though each day insurance policies are changing. Regardless if you have a brand new policy midyear, or have maintained your current policy, there are a handful of terms you should understand.

All medical offices have a fee schedule.  A fee schedule is a list of services and the amount billed to an insurance company.  These fee schedules are determined based on location and other aspects which as a patient you could care less about. On a very basic level, paying for insurance gives you the privilege of paying that companies rates.

Medical office rate for exam: $100
Blue Cross Blue Shield Rate for same exam: $80

If you have BCBS insurance, you can only pay up to $80 for that exam.  You get the $20 discount.

Here are a list of other terms you should...

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