Fixed amount or a percentage of the fee paid by a member each time a service is received. Strategies used to limit or control costs. Cost containment programs often include requirements by insurance companies for second opinions and pre-admission approvals for hospitalization. Cost containment may also refer to policies developed nationally or statewide to slow the rising expenditures on health care. Common result when a payer, such as Medicare, does not pay the full cost of health care services.
Providers then increase prices to individuals and insurers to make up the difference.
The amount a provider bills for a covered service. Medically necessary procedures, services, or supplies listed in the member's benefits certificate. Creditable coverage does not include limited benefit plans, dread disease plans, or short-term major medical if it is the coverage immediately prior to the effective date of the Basic or Standard coverage. Assistance in meeting daily living activities not requiring the continued attention and assistance of licensed medical or trained paramedical personnel. Return to Top D Deductible.