A plain-language guide Insurance words

Insurance words

Turn plan language into a clear payment question.

The formulary is an insurance plan’s list of medicines it pays for.

Prior authorization means the plan wants to give permission before it pays.

Ask about the visit first

What would my plan pay for this visit? What would I owe? Is this service within my plan’s network?

A network is the group of care services your plan has arrangements with.

Ask for the visit answer on its own. Then ask about any proposed medicine as a separate item.

Name the exact product

What medicine is being proposed? What form is it in? Is it on my plan’s list? Would permission be needed before payment?

Ask the plan for its answer using the exact product information from the care service. Keep the reply with the cost terms.

Do not let a payment answer stand in for a care answer

Selank has no FDA-approved U.S. product.

Insurance payment does not give a medicine FDA approval.

Ask about the studies and your health problem as well as who pays.

Bring the questions together

Notes for this chapter