Insurance benefits in which payment is made up to a maximum amount but does not list a specific dollar amount for each service provided.
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A reimbursement provision, usually for Mediclaim policies and such other hospitalization policies which does not specify how much will be paid for each type of treatment, examination, tests, nursing charges, operation theatre charges, operation theatre charges, dressing, medicines or the like but only sets a maximum which will be paid for all such treatments.

System of funding a retirement plan in which funds are put into a retirement plan but are not set aside to purchase retirement benefits. When a participant retires, the funding agency may either purchase an annuity or pay benefits from the fund. The funding agency does not make contract promises on specific benefit amounts.

In Medicare and TRICARE programs, insurance claim submitted for a medical service or supply by a provider who does not accept assignment. The provider must bill the fiscal intermediary and the beneficiary must pay the provider for the service. Also see nonparticipating physician (nonpar) and nonparticipating provider (nonpar) .

1. Practice of billing using numerous CPT codes to identify procedures normally covered by a single code; also known as itemizing, fragmented billing, fragmentation, exploding , or a la carte medicine . 2. Billing under Medicare Part B for nonphysician services to hospital inpatients furnished to the hospital by an outside supplier or another provider. Under the new law, unbundling is prohibited, and all nonphysician services provided in an inpatient setting will be paid as hospital services.

Insurance policy benefits when no payee can be located. When this situation occurs, the insurer holds the unclaimed benefits for 7 years and then turns them over to the state. The beneficiary’s last known address or state of domicile, whichever is known, applies.

State laws that regulate the disposition of funds when the owner cannot be located. When this situation occurs, the insurer holds the unclaimed benefits for 7 years and then turns them over to the state. Also known as escheat laws . See also unclaimed benefits .

Billed medical services provided to patients by physicians and hospital facilities for which no payment is received from third-party payers or patients (e.g., charity care, bad debtors).

Type of hospital invoice (patient’s financial accounting statement) assessed by someone auditing a hospital bill that has services that have been provided and not billed. Also see clean bill and over bill .