Billing & Insurance Glossary of Terms

Co-Insurance After you have reached your deductible amount (see below),

your co-insurance payment is the portion of the balance for covered medical expenses that you, the insured individual, must pay.

Co-Pay A co-pay is a pre-determined dollar amount specified by your insurance company. You must pay your co-pay at the time of service.
Deductible The deductible is the amount of money you, the insured individual, must pay for your medical services before the insurance plan kicks in and begins making payments.
Explanation of Benefits (EOB) Your EOB is a statement sent by your insurance company listing the services you received at 1st Class Urgent Care Center.
Guarantor A guarantor is someone (the patient or another person) who is either accepts or is legally responsible for the payment of bills for medical services.
Insured Member/ Subscriber/ Beneficiary These terms all refer to a person covered by health insurance.
In-Network A healthcare provider (physician, hospital, or clinic) is part of a health insurance plan’s network, it will accept your insurance payment for covered services as payment in full (after payment of your deductible, co- pay, and co-insurance.)
Out-of-Network If you see a healthcare provider that is not part of your heath insurance plan’s network, your cost for services may be higher, or you may be responsible for payment in full for all services.
Patient Responsibility/ Financial Responsibility These terms refer to the portion of your medical bill for which you are responsible.
Pre-Authorization This refers to the process of contacting your insurance carrier to obtain permission to perform a service before the service is performed.
Specialist A specialist is a medical provider whose primary focus is on treating certain parts of the body or certain medical conditions. At 1st Class Urgent Care, our specialty urgent care treatment, and some insurers consider a visit to us specialist visit.
Statement Balance Your statement balance is the amount you owe after your insurance plan or Medicare has paid the approved amount for your treatment.
1st Class Urgent Care