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Texas Fertility Center Group

Business Office Terms

The TFC Business Office can help you navigate the complicated world of Fertility Insurance & Fertility Financing Options.

Use our list of Business Office Terms below to start the conversation.

  • Allowed or Contracted Amount – The amount, determined by a contract between a healthcare provider and an insurance carrier that the carrier will pay the provider for a specific service.
  • Co-insurance – This refers to the portion (or percentage) of the overall medical cost of an office visit or treatment that a patient is responsible for — after any deductible is take care of. For example, if you have an ’80/20′ plan, the insurance company will pay 80% of the cost and the patient will pay 20% of the cost.
  • Co-pay – The set fee that a patient pays each time they have a doctor’s visit. Depending on the nature of the visit, there may be additional charges.
  • Deductible – The fixed dollar amount you must pay out of your own funds each calendar year before your health insurance begins to make payments for covered medical services.
  • Exclusion – A procedure or service that is not covered by your specific insurance plan.
  • Eligible Expense – An expense for a service that is covered under your plan.
  • Maternity care – Care and services provided for the treatment of pregnancy. Complications are not included.
  • Maximum Lifetime Benefits – The total amount of insurance benefits available to any one participant under an insurance plan for a lifetime; or the total amount of lifetime benefits available for a specific benefit, such as Infertility.
  • Medically Necessity – Services considered as essential for the diagnosis or the direct care and treatment of a medical condition. Such services are consistent with generally accepted standards of medical practice and are not performed primarily for the convenience of the patient or physician.
  • Network Provider – A Hospital, Physician or other provider that has entered into a contractual agreement to provide services to patients covered by a specific managed care plan.
  • Non Network Provider – A Hospital, Physician or other provider that has not entered into an agreement to participate as a managed care provider.
  • Pre-determination of Benefits – A request made to your insurance carrier that asks them to provide specific coverage details regarding a specific planned procedure.
  • Pre-existing Condition – A condition for which medical advice, diagnosis, care, or treatment was recommended or received during a specific time period prior to the date that your current insurance policy went into effect.