Itemized  ·  Glossary

Healthcare pricing glossary.

Plain-English definitions for the terms that show up on hospital bills, insurance EOBs, and price-transparency files. Bookmark this; you'll need it.

ASC Ambulatory Surgery Center Balance billing When the provider bills you the difference Cash pay Self-pay rate (no insurance) Chargemaster The hospital's sticker price Claim denial Insurance refused to pay CMS Care Compare The federal hospital quality rating Coinsurance Your % share after deductible Copay Flat fee per visit or service CPT Code Current Procedural Terminology code Deductible What you pay before insurance kicks in Deductible met Your insurance is now paying EOB Explanation of Benefits Facility fee What the building charges FSA Flexible Spending Account HCPCS Code Healthcare Common Procedure Coding System code HDHP High-Deductible Health Plan Hospital Price Transparency Rule 45 CFR 180.50 — the rule that makes prices public HSA Health Savings Account In-network Has a contract with your insurer MRF Machine-Readable File MS-DRG Medicare Severity Diagnosis-Related Group Negotiated rate What your insurer actually pays No Surprises Act Federal law against surprise bills Out-of-network No contract with your insurer Out-of-pocket maximum The annual cap on what you pay Pre-existing condition Medical condition you had before coverage started Preauthorization Insurance must approve in advance Professional fee What the doctor charges Section 501(r) Charity care for non-profit hospitals Self-pay discount Off-list price for paying without insurance TiC Transparency in Coverage rule