Status of an insurance claim when all benefits have been paid.

Insurance agreement in which rates and policy provisions cannot be changed between the policy owner and the insurer. Commercial insurance companies write closed contracts. Fraternal insurance companies are not permitted to write this type of insurance.

List of drugs covered by a benefit plan in which the drugs on it are the only ones covered. Sometimes nonformulary drugs can be covered if authorization is obtained and if there is a good medical reason. See also open formulary and restricted formulary.

Fracture of the bone with no skin wound.

Decision that has been made and cannot be appealed or is not under appeal by the member of a managed care plan.

Form of health maintenance organization (HMO) that limits the patient’s choice of personal physicians to those doctors practicing in the HMO group practice within the geographical location and/or facility. Such plans allow members to receive nonemergency medical services, but adhering to a closed panel is usually not applicable to emergency care. A physician must meet very narrow criteria in order to join a closed panel.

Alignment of a fracture without the site opened for surgical intervention. Three treatment methods for closed fractures exist: without manipulation, with manipulation, and with or without traction.

That portion of the insurance sales presentation when a prospective applicant has made a purchase commitment for insurance coverage and signs the sales proposal or application form.
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Completion of an insurance.

Situation in which a provider bills for midlevel services for various patient encounters under the assumption that some visits will be a little higher and some will be a little lower (upcoding some services and downcoding other services).