1. When each entry in a patient’s medical record is worded exactly alike or similar to the previous entries. 2. When medical documentation is worded exactly the same from patient to patient. Cloning is considered a misrepresentation of the medical necessity requirements for insurance coverage of medical services. If suspected or identified, the services will be denied and may result in recovery of any overpayments made.

Conclusion of the sales presentation that leads to the signing of the insurance application.

Managed care plan that requires enrollees to select a primary care physician (PCP) from the plan’s approved panel of providers. The PCP acts as a gatekeeper and may refer the patient to a specialist when required.

To take into one’s own family by legal process and raise as one’s own child, but the identifying information about the adoptive and birth families is not shared. The adoptive and birth families do not establish or maintain contact.

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.