Assignment of Benefits (AOB)
A written authorization signed by you which permits payment of benefits directly to the provider (CVS Caremark) who rendered services to you.
Copayment or Coinsurance
The portion of the medical bill you must pay after the insurance company pays their portion.
A fixed amount that you must pay each policy year before any benefits will be considered by the insurance company.
Explanation of Benefits (EOB)
A statement that is sent to you by your insurance carrier explaining the action taken by them on your health insurance claim.
The maximum amount your insurance company will pay toward claims in your lifetime. Once this maximum has been reached, no benefits will be paid under the terms of the policy.
The process undertaken by your insurance company to review your medical documentation to ensure that the need for therapy meets the coverage requirements of the insurance company.
The amount you must pay each policy year before the policy starts paying maximum benefits. Sometimes an out-of-pocket maximum must be reached on a family basis and sometimes on an individual basis.
Payor or Third-party Payor
An entity (either a private insurance carrier or federal or state program) that administers and is responsible for the payment of health care benefits.
The authorization to provide designated services given by some insurance
companies to the provider (CVS Caremark) before the services can be supplied.
The process by which payment for health care products and services is obtained from a third-party insurer, either a private insurance carrier or a federal or state program.