The costs of health care services that are not paid for by the patient or by the insurer. Federal programs sometimes offer some help to providers to offset the cost of providing uncompensated care.
Individuals who have health insurance but cannot access needed providers or cannot afford the cost sharing requirements.
The process through which an insurer studies an individual or group applying for insurance and makes a decision on whether or not to offer coverage and how to price that coverage.
Uniform Coverage Summaries
Provision in the Affordable Care Act requiring insurance providers to present uniform summaries of benefits and coverage (SBC), designed to allow consumers to understand and compare their coverage options.
Individuals who do not have health coverage.
Refers to a system under several health care reform proposals that would offer health care coverage to all Americans.
The base price of insurance before applying any credits or adjustments.
Health care that requires expedient attention, but is not severe enough to necessitate a visit to the emergency room.
Usual, Customary or Reasonable (UCR)
An industry term for the typical rates charged for services in a specific region. For example, if a surgeon in Virginia were to charge twice as much for a surgery as the average cost of that procedure in the area, those charges would not be considered usual, customary or reasonable.
The number of times enrollees take advantage of particular health care benefits.