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basic terminology 1

Across
A cost sharing arrangement in which the Aetna enrollee pays a specified flat amount for a specific service (such as $20 for an office visit.)
______ code - Code that represents a written description of diseases, illnesses and injuries
Health _____ Account) - a tax-deductible account which pays for qualified medical expenses for individuals covered by a qualified high-deductible health plans
____ providers - Providers that have contract with us
a set amount of money that a member or family must pay for covered medical services each calendar year before Aetna will pay any claims for covered services
Health Network ____: HMO-based plan that has two levels of benefits and Open Access to all participating providers
Down
The member’s share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service
The reason that a procedure would be denied with action code 780.
______ access: Ability to obtain a benefit by going to a specialist without a prior written referral from the primary care physician
Somebody covered on a plan who is NOT the insured.