Healthcare Terms You Need to Know
Healthcare Transparency
Healthcare transparency refers to the practice of providing accessible, understandable, and relevant information about healthcare services, costs, quality, and outcomes to patients, healthcare providers, and other stakeholders. The goal of healthcare transparency is to empower individuals to make informed decisions about their healthcare, improve the quality of care, and control healthcare costs.
Pricing Transparency in Healthcare
Healthcare pricing transparency guidelines are intended to provide a framework for healthcare providers, insurers, and other stakeholders to make healthcare costs more transparent and understandable to patients and consumers. These guidelines aim to empower individuals to make informed decisions about their healthcare by providing clear information about the prices of medical services, procedures, and treatments.
Hardship in healthcare
You could qualify for a hardship exemption if you had a financial hardship or other circumstances that prevented you from getting health insurance.
What counts as hardship?
You were homeless, were evicted or were facing eviction or foreclosure.
You got a shut-off notice from a utility company.
You experienced domestic violence.
You experienced the death of a family member.
You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
You filed for bankruptcy.
You had medical expenses you couldn’t pay that resulted in substantial debt.
You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
You claim a child as a tax dependent who’s been denied coverage for Medicaid or the Children’s Health Insurance Program (CHIP), and another person is required by court order to give medical support to the child.
As a result of an eligibility appeals decision, you’re eligible for enrollment in a health plan through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a period when you weren’t enrolled in a qualified health plan through the Marketplace.
You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.
You had another hardship. If you experienced another hardship obtaining health insurance.
The period for the application for hardship is the month before, the month applied, and the month after the application was submitted.
E.O.B. (Explanation of Benefits)
An EOB is a statement from your health insurance plan describing what costs it will cover for medical care or products you've received. The EOB is generated when your provider submits a claim for the services you received.
Financial Assistance
Financial assistance programs, sometimes called “charity care,” provide free or discounted health care to people who need help paying medical bills. These programs can help patients who do not have insurance and patients who have insurance but are underinsured. These programs may be provided by your medical care provider and your state. Additionally, there may be non-profit organizations or advocacy groups that can help you.
Deductible VS. Out of Pocket expenses
An out-of-pocket maximum is higher than a health insurance deductible because it's the most you'll pay for in-network health care services in a year. A deductible is your portion of health care costs before a health insurance company kicks in money for care.
Insurance EOB Patient Responsibility
Patient responsibility is the portion of a medical bill that the patient is required to pay rather than their insurance provider. You may be responsible to pay an amount of the charges/service. This amount is based on your insurance benefits and what the facility and provider charge. The actual billing statement and amount you owe will be sent from the health care facility that provided the service.