Learn
Short, plain-language guides to help patients and caregivers feel less lost when talking to providers and insurance companies.
Deductibles, coinsurance & out-of-pocket maximum
How the three numbers that drive your bills actually work — with a worked example.
Read →Non-duplication of benefits
Why having two health plans often doesn't mean double coverage.
Read →Medical necessity, explained
What insurers actually mean by this phrase, and what they typically review.
Read →How prior authorization works
Who submits it, how long it takes, and what to do if it's denied.
Read →Why something might be called "investigational"
What this term means in insurance policies — and how it changes.
Read →How to call your insurance plan
Exactly what to ask, what to write down, and how to escalate.
Read →Full insurance glossary
Every term grouped by topic: what you pay, coverage rules, plan mechanics, and policy terminology.
Open glossary →Provider specialties
Who does what — primary care, internal medicine subspecialties, surgical specialties, and behavioral & rehab providers. When to see each, and how referrals usually flow.
Browse specialties →Quick glossary by category
What you pay
The monthly amount you (or your employer) pay just to have the plan.
What you pay out of pocket before your plan starts sharing most costs.
A flat dollar amount you pay at the time of a visit or prescription.
Your percentage share of a covered cost after the deductible is met.
The most you'll pay for covered, in-network care in a plan year.
The negotiated price your insurer recognizes for a service.
When an out-of-network provider bills you for the gap above what your plan paid.
The statement from your insurer showing what was billed, allowed, paid, and what you owe.
Coverage rules & reviews
The insurer is reviewing whether the service is clinically appropriate for your situation.
Some services may need plan approval before they are performed.
The insurer considers the service still under study for this use.
Lower-risk care that insurers may want documented before a bigger procedure.
The insurer may view the service as appearance-related rather than treating a medical condition.
How insurers review whether services are clinically appropriate and efficient.
Trying a preferred (often lower-cost) treatment first before a different one is approved.
How your plan works
Providers who contract with your plan cost less than those who don't.
A written order from your primary care provider to see a specialist.
The doctor who manages your overall care and coordinates referrals.
When you have two plans, the secondary will not pay more than it would have if it were primary.
Rules that decide which of your plans pays first when you have more than one.
Some plans group in-network providers into preferred and standard tiers.
The 12-month window your deductible and OOP max reset on.
How a family plan's deductible applies to one member vs the whole family.
Policy terminology
The list of medications your plan covers, often with tiers.