Double Insurance

If the insurance policy is taken from more than one underwriter where total or part of period of insurance, total or part of subject matter of insurance and total or part of sum insured are same, then this is called double insurance. Double insurance is for period, subject matter and sum insured for which both the policies run concurrently.
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See: Contribution.

Doughnut hole

Also spelled donut hole . Another name for the step in a Medicare Part D plan in which the patient pays all of the expenses for eligible drugs until he or she has spent $3850. Also referred to as coverage gap or The gap .

Down time

Period during which a computer, communications line, or other device is malfunctioning or not operating correctly because of mechanical or electronic problems.

Downcoding

1. Coding system used by the physician’s office does not match the coding system used by the insurance company receiving the claim. The insurance company computer system converts the procedure code submitted to the closest code in use, which is usually down one level from the submitted code, generating decreased payment. Sometimes downcoding may occur when the diagnosis code does not support the level of care. 2. Selecting procedure codes at a lower level than the medical service requires or documentation supports. Also called undercoding . Also see penalized claim.