Healthcare Glossary

Physical Therapy Visit - Exercises to help your body heal.

Occupational Therapy Visit - Help with daily activities.

Speech Therapy Visit - Help with speaking or swallowing.

Annual Checkup - A regular visit to check your health.

Office Visit - A visit to see a doctor or nurse.

Physical Exam - A head to toe health check.

Well Child Visit - A checkup for a child

Biopsy - A small piece of tissue is taken to test.

Cataract Surgery - Surgery to fix cloudy vision.

Colonoscopy - A test that checks the inside of the colon.

Endoscopy - A test that looks inside the stomach.

Joint Injection - Medicine placed into a joint to reduce pain.

Ear Wax Removal - Cleaning wax from the ear.

Mole Removal - Removing a spot on the skin.

Skin Tag Removal - Removing a small piece of skin.

Wound Stitches - Closing a cut with stitches.

Copay - Money you pay when you see the doctor.

Covered Services - Care your insurance will help pay for.

Deductible - Money you pay before insurance helps.

Insurance - Help paying for healthcare.

Premium - Money you pay each month for insurance.

CT Scan (CAT Scan) - A special X-ray that shows more detail.

Mammogram - An X-ray of the breast.

MRI - A machine that takes detailed pictures inside your body.

Ultrasound - A test that uses sound waves to see inside your body.

X-ray - A picture to see your bones inside your body.

Acute Illness - A sickness that starts fast and ends soon.

Chronic Condition - A health problem that does not go away.

Diagnosis - The name of your health problem.

Prevention - Ways to keep from getting sick.

Symptoms - How your body feels when something is wrong.

Emergency Room (ER) - A place you go right away for serious problems.

Hospital - A place where people go when they are very sick or hurt.

Primary Care Provider (PCP) - Your main doctor or nurse.

Specialist - A doctor who helps with one health problem.

Urgent Care - A clinic for problems that cannot wait but are not emergencies.

A statement your insurance company sends after it processes a claim. An EOB is not a bill. It shows what the provider charged, the rate your insurer allows, what the insurer paid, and the portion left to you. Comparing the EOB against the bill you receive from the provider is the fastest way to catch a billing error.

The share of a covered cost you pay as a percentage, after you have met your deductible. If your plan sets coinsurance at 20%, you pay 20% of the allowed amount and your insurer pays the rest, until you reach your out-of-pocket maximum.

A fixed amount you pay for a specific service, such as an office visit or a prescription. Unlike coinsurance, a copay does not change with the price of the service. Depending on the plan, copays may or may not count toward your deductible.

The amount you pay for covered services before your insurer begins paying its share. Deductibles reset on your plan year, so care received late in the year may cost you more out of pocket than the same care received after the reset.

The most you will pay for covered, in-network services during a plan year. Once you reach it, your plan covers 100% of further covered costs for that year. Premiums, out-of-network charges, and non-covered services generally do not count toward it.

The maximum a plan will count toward a covered service, also called the negotiated or eligible amount. It is usually lower than the provider's list price. Your coinsurance is calculated from the allowed amount, not from the amount the provider originally charged.

The request for payment a provider submits to your insurer after you receive care. The insurer processes the claim, applies your plan's terms, and reports the outcome on an Explanation of Benefits. A claim can be denied for clinical reasons or for administrative ones such as a coding or eligibility error.

Approval a plan requires before it will cover certain services, medications, or procedures. Without it, the plan may deny the claim even when the service is otherwise covered. Confirming whether prior authorization is needed before scheduling is one of the more effective ways to avoid an unexpected bill.

Providers who have a contract with your insurance plan setting the rates they accept. In-network care is normally the least expensive option, and only in-network spending counts toward in-network deductibles and out-of-pocket maximums.

Providers without a contract with your plan. Out-of-network care may be covered at a lower rate, or not at all, and the provider is not bound by a negotiated price. Network status can differ between a facility and the individual clinicians working inside it, so both are worth confirming.

A hospital's full internal list of prices for every item and service it bills. Chargemaster prices are list prices and rarely reflect what an insurer or a cash-paying patient actually pays, which is why comparing negotiated rates is more useful than comparing list prices.

Current Procedural Terminology codes are the standard five-character codes identifying medical procedures and services on claims and price files. Because the same procedure carries the same CPT code across providers, these codes are what make prices comparable between hospitals.

A structured data file that hospitals and insurers publish listing prices, including negotiated rates. MRFs are built for software rather than for reading directly, and they are the underlying source of the pricing comparisons on this platform.