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About medical insurance?


i need to know what these words mean in reference to medical insurance:
1. eligibility
2. Authorization
3. verification
4. consultation

Eligibility = whether a person is eligible for insurance coverage (i.e. that they either have their own coverage or are eligible as a dependent on someone else's policy, premiums are paid current, etc.) You are "eligible" for coverage if your policy is in effect. (Eligibility can be retroactively denied under certain circumstances, by the way. For example, in cases of fraud...you can be wiped off the policy as though you never had any coverage at all.)

Authorization = permission that needs to be given for certain services. This can vary from policy to policy - if you're wondering whether certain services require prior authorization on your policy, contact your insurer. Don't assume anything - "I didn't know" won't get you off the hook if you have something done without authorization. Be proactive.

Verification = a doctor's office will verify your benefits by calling your insurer and making sure that the policy is still active, what sort of coverage you have for the service they want to provide (ex - if a procedure is covered or not, at what percentage, any limitations on number of visits, etc.)

Consultation = A consultation with a medical provider. Generally you'd just be doing talking with the doctor at the consultation (hence the reason why its not an "office visit")...they aren't providing any treatment, etc. Just consulting with you about future options. Note: You won't always have coverage for "consultations" on all policies, it varies depending on what the consultation is for and whether or not you proceed with treatment/surgery based on the results of that consultation.


(Note - these are very general definitions of the above terms, if you give more specifics as to your situation I might be able to give more specific advice.) Source(s): many years work in benefits consulting, insurance, and medical billing
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insurance policies insurance premium insurance settlement health insurance medical insurance healthcare insurance dental insurance travel insurance auto insurance car insurance
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