Common Insurance Terms (if you don't see it here just ask and then we'll add it)

Balance Billing
Coinsurance
Copay
Deductible
EOB
HMO
In Network
Network Negotiated Rate
Out of Network
PPO
Provider

Balance Billing -- The process where an out of network provider bills you the remainder of the amount billed that the insurance company doesn't approve. If a doctor bills $200 for a service and the insurance company only approves $120 of that bill then you'd be responsible for your portion of the $120 AND also the $80. The $80 would be the amount that was balance billed. When you see an in network provider the $80 (in this example) would go away because the doctor is contractually obligated to accept the $120 as payment. How much you would owe of the $120 would depend on the plan you have.
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Coinsurance -- After you meet the deductible is when you start to share the cost with the insurance company. This is called “coinsurance.” The way our quote engine list the coinsurance is the amount you would pay. So, if it says 20%, you’d pay that amount of future bills. If it says 0%, then you’d pay no more of the covered expenses after the deductible is met
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Copay -- Some plans have flat amounts that you pay for services. These flat amounts are called copays. Usually they are completely unrelated to and don't count towards your deductible. So, if a plan had a $25 copay for office visits, regardless of what your deductible is you would pay $25 when you visit the doctor. You need to check the plan to understand whether the number of visits is limited during the year AND what services are covered under the copay. Plans with copays are not necessarily better, but some consumers like to know what they're going to pay when they have a doctor's visit. Don't pay much more for a plan with a copay over one without.
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Deductible -- This is the amount of a bill (or cumulative bills) you would be responsible for before the insurance company starts paying (or sharing) the cost of medical bills. The bills you incur usually apply towards your deductible; therefore, if you have no bills then you won't pay a deductible. It's important to understand what types of bills are subject to a deductible as some items are covered by a copay .

Also is your deductible "per incident" or "annual?" Per incident means EVERY time you go to the hospital, for example, so you start at zero for each incident. Whereas an "annual" deductible allows you to accumulate your bills to meet the deductible and get the plan to start paying. Annual is better. Higher deductibles usually equate to a lower cost plan, BUT a lower deductible isn't necessarily better. In other words, if a lower deductible plan costs more than the difference between that and a higher deductible, you should consider the higher deductible. (if a $250 deductible costs more than $500 a year than the $750 deductible (and there are no other differences) choose the $750.
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EOB -- Explanation Of Benefits. This is the form you get in the mail after you incur a medical expense. The provider bills the insurance company or network and the rate is usually adjusted to reflect the network negotiated rate or the URC (usual, reasonable, customary) charge. After the charge is adjusted the "allowed" amount travels through the insurance. Never pay a doctor or hospital bill until you've matched it up with the explanation of benefits, that's the only way you'd know if you were actually responsible for paying the bill and whether the provider billed the insurance company .
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HMO -- a network of providers much like a PPO. The difference with an HMO is you have a primary care physician. The primary care physician is the one responsible for your care. When you need care that is outside his/her expertise then they can refer you to a specialist (an orthopedic, gastroenterologist, ENT, etc..). With an HMO you normally can't circumvent the primary care doctor and go directly to the specialist. The idea of an HMO is that the primary care doctor is equipped (with the knowledge) to care for you the majority of the time. Therefore it can eliminate needless trips to a specialist which would just add to the cost of your care.
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In Network -- a provider that is part of the PPO or HMO network and has agreed to accept the network negotiated rates for services they provide.
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Network Negotiated Rate -- This is the fee that the provider (doctor, hospital, lab, etc...) has agreed to accept for a particular service. This amount is usually less then what they would normally charge. If you have a discount plan this amount would be your responsibility. If you have insurance this is the amount that would be applied towards your deductible and coinsurance. If you have any "EOBs" lying around you'll see a "charged rate" and an "amount allowed." The amount allowed is the negotiated rate. If you are "out-of-network" then the difference between these amounts is also your responsibility outside of the plan.
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Out of Network -- A provider that is not part of the PPO or HMO network. When you see someone out of network you run the risk of being balance billed because the provider's rate for services has been agreed to (see network negotiated rate) by the insurance company.
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PPO -- Preferred Provider Organization - A health care organization composed of physicians, hospitals, or other providers which provides health care services at a reduced fee (see Network Negotiated Rate). When you see a doctor that is part of the PPO (a.k.a. ‘in network’) then you know that the insurance company and the doctor have already agreed upon a rate. When you see a doctor that is NOT part of the PPO (a.k.a. ‘out of network) then you run the risk of being balance billed. You should never be balance billed when you’re seeing in-network doctors. .
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Provider-- The person or place that gives (or provides) you medical treatment...a doctor, hospital, lab, etc...
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