Glossary of Health Insurance Terms

See "Technical Component."

The charge for performance of mechanical operating procedures, including cost of materials and use of equipment, associated with securing an x-ray or a laboratory test specimen.

The provision of consultant services by off-site physicians to health care professionals on the scene by means of closed-circuit television; the ability of health care providers to examine patients, not in person, but by means of a computer screen.

See "Blue Plan."

An organization that is outside of the insuring organization that handles the administrative duties and sometimes utilization review. Third party administrators are used by organizations that fund the health benefits but do not find it cost effective to administrate the plan themselves.

An insurance carrier or governmental agency that reimburses for health care services provided to a patient. The provider and the patient are the first two parties of the delivered service.

Medicaid, which is a federally and state funded welfare program.

Medicare, which is a federally funded program for those 65 and over and those disabled.

See "Type of Service."

A pre-paid fee-for-service health plan that gives members maximum freedom of choice, allowing them to seek medical care from any healthcare provider without reduction of benefits.

Professional service rendered by a provider.

A written report showing the provider's recommended course of tests, modalities, medicines, etc. See "Medical recordkeeping."

The military's integrated health care deliver system. The TRICARE system includes the Civilian Health and Medical Program of the Uniformed Services - CHAMPUS. TRICARE gives the regional military treatment facilities control of health care deliver costs and purchasing. The TRICARE system splits U.S. military bases into 12 designated regions. One major military health care facility within each of the regions is designated as the "lead agent," which is responsible for organizing and maintaining an integrated delivery network, including civilian providers. BCBSKS participates in TriWest, which is the deliverer of care for this region.

See “TRICARE.”

See "Treatment."

See "Benefit, type of."

A one-digit code used with the procedure code to identify a specific category of service.