Confusing Health Insurance Terms Defined

Health insurance can be very confusing.  It is probably one of the reasons some people don’t purchase it.  Or if you do have health insurance, you may be uncertain of how it works, making trips to the doctor very uneasy as you do not know if it will be covered or not.  Knowing some of the common terms in health insurance will help you be more confident in your next medical appointment.  Below is a list and definition of some of the confusing insurance terms.

HMO and PPO

HMO (Health Maintenance Organization) gives you access to healthcare services centralized through your primary care physician.  This will require you a referral if you are to visit another physician.  A PPO (Preferred Provider Organization) on the other hand will allow you to visit a physician of your choice.  However, this flexibility can cost a bit more.  

HSA and HRA

HSA or a Health Spending Account is similar to your retirement account.  You put aside an amount of money and this will be used for medical expenses.  HRA or Health Reimbursement Arrangement is created by your employer.  This fund is used for employees to reimburse medical expenses not covered by their health plan.  

Step Therapy

This type of treatment is when you first utilize lower-cost medication before “stepping up” to more expensive treatments.  If the original treatment or medication does not relieve your symptoms, you may opt for a more expensive treatment.  This more expensive treatment may not be covered by your insurance if the lesser cost medication was not tried first.

Prior Authorization

To ensure that your medication is the best fit treatment for you, insurers will first review it.  This is what Prior Authorization is all about.  Not all medication will require a prior authorization.  Below are some of the prerequisites for medication to need prior authorization.

• Often abused drugs
• Only for very specific medical conditions
• Dangerous side effects or effects when mixed with other drugs

Coordination of Benefits

You may have more than 1 health insurance.  Coordination of benefits comes in to ensure you get the most from the different health insurance providers.  Your primary plan will cover the expenses first, and your secondary plan will cover the remaining expenses.  Coordination of benefits helps you claim faster and reduces out-of-pocket expenses.


It is important to know the details of your health plan.  This will not only give you confidence in seeking treatment but also give you peace of mind.  The better you understand, the better equipped you are. At Roper Insurance Services, we aim to provide comprehensive insurance policies that makes your life easier. You can get more information about our products and services by calling our agency at (828) 697-6709. Get your free quote today by CLICKING HERE.

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