Reason for the patient’s office visit such as complaints, condition, disease, findings, illness, injury, signs, or symptoms.

Appeal by a physician to a third-party payer for medical services not yet provided to the patient. Also see appeal, postservice appeal, and expedited appeal.

Legal assumption that a fact exists.

Assumption of total disability when an insured is considered totally disabled (blindness, loss of hearing, speech, or limbs). The insurance company may pay a lump sum in addition to monthly payments for a maximum benefit period.
***
A disability involving loss of sight, hearing, speech or any two limbs, which is presumed to be a permanent and total disability. In such cases, the insurer does not require the insured to submit to periodic medical examinations to prove continuing disability.

A federal/state program designed to ease access to prenatal care offering immediate temporary coverage to low-income women pending a formal Medi-Cal application.

Possible biological father of a child but not necessarily the legal parent or the confirmed father. Also referred to as alleged father.

Fee that is most frequently charged in an area by a specialty group of physicians. The top of this range establishes an overall limitation on the charges that a carrier, which considers prevailing charges in reimbursement, will accept as reasonable for a given service without special justification. In the Medicare program, this factor was previously used in determining payment.

Number of existing cases of a disease or condition in a defined population at a specific time. Calculation: Divide the number of persons with the disease by the total population of the defined group to obtain the prevalence rate of a disease.

Action taken to diminish the onset of disease or an injury such as hand washing, refrigeration of foods, no smoking, little or no alcohol intake, prenatal care, and exercise.
***
Elimination of causes of loss.