The Independent Medical Review Program

9 Assignment of Benefits – Your signed authorization to your doctor or hospital (medical provider) to collect monies for your medical treatment from your health insurance company. Business Day – Every day that insurance companies are open for business which excludes Saturday, Sunday, and state and federal holidays. Calendar Day – Every day of the calendar month which includes Saturday, Sunday, and state and federal holidays. However, if any action tied to a time frame in an insurance policy or CDI regulation or code falls on a Saturday, Sunday, or state or federal holiday; then the action is postponed to the next calendar day that does not fall on a Saturday, Sunday, or state or federal holiday. Certificate of Coverage – A document issued to a member of a group health insurance plan showing evidence of participation in the insurance. Claim – A notification to your insurance company that payment is due under the policy provisions. Copayment – The portion of charges you pay to your provider for covered health care services in addition to any deductible. Coverage – The scope of protection provided by an insurance contract which includes any of the listed benefits in an insurance policy. Denial – An insurance company decision to withhold a claim payment or pre authorization. A denial may be made because the medical service is not covered, not medically necessary, experimental or investigational. Deductible – A fixed amount which is deducted from eligible expenses before benefits from the insurance company are payable. Health Insurance Terms and Phrases?