Insurance Glossary

Your health plan and Wee Care Pediatrics may use a series of terms you may not know. This section will better help you understand many of the terms used to explain your benefits.

PCP– Primary Care Physician (your assigned doctor)

HMO– Health Maintenance Organization (requires a PCP)

PPO– Preferred Provider Organization (does NOT require a PCP)

Primary Insurance– This plan would be billed first if you have double coverage

Secondary Insurance– This plan would be billed second (keep in mind, secondary insurance does not always pick up all copays or deductibles billed from primary)

*Primary and Medicaid* – When a patient has a commercial insurance plan and Medicaid, the commercial plan will always be the primary plan and your Medicaid plan will always be secondary. Medicaid will not reimburse any claims until your primary or commercial insurance is billed first. Medicaid will ask for payment back from your doctor if it finds there is a primary or commercial insurance that should have been billed first. The State of Nevada is very strict on this rule.

COB or Coordination of Benefits– Your insurance carrier is inquiring whether you have more than one insurance plan for your child. You must respond even if you don’t have other coverage. All billed claims will deny if you do not respond in time. This is typically done on an annual basis so be sure to respond, you will be held financially responsible by your insurance carrier and will be billed the full amount not reflecting your insurance discount. A simple call fixes it all!

Copay– This is a fixed amount you pay towards services provided by your doctor that is part of the whole payment allowed by your insurance plan.

Deductible– This is a set amount agreed upon when selecting your insurance plan, you are responsible for paying the first dollar amount in medical care. For instance, if your deductible is $1500.00 per year, each time you or your family member receives medical care, you pay the doctor for services rendered instead of your insurance plan paying the doctor until you have reached $1500.00 of medical care. Once your deductible is met, your copay or co-ins amount kicks in for the remainder of the year. Deductibles start over on an annual basis.