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Glossary of Health Insurance Terms

As you explore our site, you may come across an unfamiliar word or term. We've developed a glossary of health care terms we hope will help you.

Select one of the following letters to take you to the part of the alphabet that applies.

S

Second Level Appeal - See "Final Level Appeal."

Secondary Carrier - The insurer who processes the services after the primary insurance carrier has made their adjudication of the services.

Self-Referral Option -SRO - The Blue Select patient may see the provider of their choice without a referral from their PCP. When this option is used the covered services are allowed at a lower benefit level.

Sequence Number - See "Internal Control Number."

Service - Treatment, care or item provided to a patient. See "HCFA Common Procedure Coding System" and "Procedure Code."

Service Area - The area in which the provider practices or has their business.

Shared Pay Comprehensive - Under this program the patient pays 50 percent of the allowed charge on covered services up to a designated amount. BCBSKS pays the other 50 percent. The patient's premiums are usually less costly with this plan.

Shared Payment Credit - The expense incurred under a patient's contract that is transferred to another contract. For this to happen, the expenses and contract effective dates must be in the same contract year.

Shield - See "Blue Shield of Kansas" and "Anthem Blue Cross and Blue Shield, Inc."

Single Coverage - Only the member/member -patient is covered as opposed to family coverage where the member/member, the spouse, and dependent children are covered.

Single Membership - See "Single Coverage."

SOAP Notes - See "Subjective, Objective, Assessment and Plan Documentation" and "Medical Recordkeeping".

Social and Rehabilitation Services -SRS - The State of Kansas department that oversees Outpatient Substance Abuse Facility licensing. This is also the department that regulates the state Medicaid program.

SOCP - See "Explanation of Benefits."

SP - See "LSP."

Special Account Group - A health care plan offering a program that encompasses benefits and/ or medical services outside of normal benefits.

SRO - See "Self Referral Option".

SRS - See "Social and Rehabilitation Services" .

SSA - Social Security Administration.

State-Wide Average - The average charge made by BCBSKS contracting providers for a given service.

Steering Committee - The group of BCBSKS employees that are responsible for overseeing the running of the company. This committee is comprised of the President and Vice-Presidents.

Stop Loss - See "Individual Stop Loss."

Stop Loss Provision - See "Individual Stop Loss."

Subjective, Objective, Assessment and Plan Documentation -SOAP - An accepted method of recordkeeping to support the medical necessity and actual services rendered to our members/members -patients. See "Medical Recordkeeping."

Subrogation - BCBSKS' right to recoup monies paid when another insurer has legal responsibility for payment of expenses. The substitution of one for another as creditor so that the new creditor succeeds to the former's rights or obligations.

Subscriber Accounting - The department at BCBSKS that has responsibility of billing and setting up the eligibility of our BCBSKS members -patients.

Summary of Claims Processed - See "Explanation of Benefits."

Supplemental Medical Insurance - See "Medicare Part B."

Suspended Claim - A request for payment that has been delayed for payment until further development can occur.

Suspense Item - See "Suspended Claim."