Glossary of Health Insurance Terms

Doctor of Optometric Medicine

Overdose.

Right eye.

The setting in which services are provided to a patient who is not seen in an inpatient or an outpatient hospital setting -i.e. provider's clinic, place of business.

The procedure whereby BCBSKS recoups overpayments to contracting providers by deducting monies from current payments before they are mailed.

The computerized logging of incoming and outgoing calls to and from BCBSKS Customer Service Center. The correspondents type the information from the calls into the computer. They log the date of the call, the patient, the person-s talked to, the nature of the concern and any follow-up action planned to resolve the problem.

The day the illness or symptoms began. For specialty providers, we are only interested in the accident date.

Opticians of America.

Optician.

A health plan that lets a member visit any doctor in the plan's network. A referral isn't needed from a primary care physician.

A period during which individuals not previously enrolled in the health insurance plan are allowed to apply for coverage or change their coverage status.

Left eye.

See "Outpatient Substance Abuse Facility."

Occupational Safety and Health Administration of the Federal government.

Occupational Therapist.

The anti-duplication provision of the patient's contract that limits benefits being paid by multiple insurers to 100 percent of the expenses covered and to designate the order in which the liability lies. -This was previously referred to as COB or Coordination of Benefits.

See "Online Tracking Inquiry System."

Both eyes.

Any location other than the 103 counties in Kansas over which BCBSKS has jurisdiction. See "Anthem Blue Cross and Blue Shield, Inc." and "Kansas Plan Area". BCBSKS is a mutual company and actually is not a Plan, but for ease of understanding and reading we refer to BCBSKS as a Plan.

The money the patient pays for their medical care. Usually defined in their contract to be a certain amount in relationship to the coinsurance and/or deductible. See "Individual stop loss."

Someone or something that does not fall within the norm; typically used in utilization in as a provider who uses either too many services or too few services, or both. For example: anyone whose utilization differs two standard deviations from the mean on a bell curve could be termed an outlier from their peers.

The setting in which services are provided to a patient who is seen in a non-inpatient setting -i.e. outpatient department of hospital, ambulatory surgery center, can also refer to the office setting.

An entity licensed through State of Kansas Department of Social and Rehabilitation Services -SRS to provide substance abuse care.