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Recall Alert

There is a voluntary recall of Potassium Chloride Extended-Release Capsules. Learn more

Billing and insurance glossary

Navigating and understanding billing and insurance terms can be confusing and overwhelming. Below is a list of commonly used billing and insurance terms and their definitions.

If you have questions about billing or insurance at Boston Children's, please call Patient Financial Services at 617-355-3397.

  • Claim: a request for a benefit (including reimbursement of a health care expense) made by you or your health care provider to your insurance plan for items or services you think are covered
  • Coinsurance: a percentage of the costs of a covered health care service you pay after you have paid your deductible
  • Coordination of benefits: determining which health plan pays first when a member uses two or more health plans
  • Copayments or copays: a fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service; amount can vary by the type of covered health care service
  • Deductible: the amount you pay for covered health care services before your insurance plan starts to pay. After you pay for your deductible, you usually pay only a copayment or coinsurance for covered services.
  • Dental coverage: health plan benefits that help pay for the cost of visits to a dentist for basic or preventive care, including teeth cleaning, x-rays, and fillings
  • Dependent: any person who is covered by your plan
  • Flexible spending account (FSA): an arrangement through your employer that lets you pay for out-of-pocket medical expenses, including copays and deductibles, with tax-free dollars
  • Group number: a unique identification number given to each group insured with the same insurance company; typically found on your insurance card
  • Guarantor: the person responsible for paying the bill
  • In-network: institutions and providers that accept your insurance plan
  • Out-of-network: your expenses for medical care that are not reimbursed by insurance. The guarantor is responsible for payment.
  • Payor: an insurance company that finances/reimburses the cost of health services for its members. Examples include Aetna, Blue Cross, etc.
  • Prior authorization: approval from an insurance plan that may be required for certain services before you receive them
  • Referral: a written order from your primary care doctor for you to see a specialist or have certain services covered
  • Subscriber: the person enrolled for benefits with the insurance company
  • Vision coverage: a health benefit that covers portions of vision care, including eye exams and glasses