Real answers · Your bills and your plan
Are these real health insurance terms?
The real answer
Yes. Every term in the demonstration above is a real term of art in American health insurance. The consumer terms, among them allowed amount, usual, customary and reasonable, coordination of benefits, prior authorization, deductible, coinsurance, copayment and out-of-pocket maximum, are defined in the federal government’s own glossary at HealthCare.gov, and the qualifying payment amount is defined in the No Surprises Act (42 U.S.C. § 300gg-111(a)(3)(E)). Relative value units, the conversion factor and the geographic cost-of-practice index come from the Medicare physician fee schedule law (42 U.S.C. § 1395w-4). Place of service and modifiers are part of Medicare’s own coding rules (CMS), and claim adjustment reason codes and remittance advice come from the standard code lists claims are paid with (X12).
The house’s version
A demonstration, by the house’s engineers.
A parody, from The Explanator.