Balance Billing

Billing a member or other responsible party for the difference between the insurer's payment and the actual charge.

Behavioral HealthCare

The provision of mental health and substance abuse services.


Services available to a member as defined in the contract. Benefit design includes the types of benefits offered, limits (e.g. number of visits, percentage paid or dollar maximums applied), and subscriber responsibility (cost sharing components).

Billed Fee

The amount charged by a provider for a specific service.

Billing Address

The address to which a billing statement will be sent.

Board Certification

A process by which a physician who has been tested for proficiency in a medical specialty or subspecialty, by a medical specialty board, has passed those tests and therefore been certified as proficient in that medical specialty.

Board Eligible

Denoting a physician who has completed the educational requirements necessary for eligibility to take the specialty board examinations.

Brand Name Drug

A prescription drug that has been patented and is only available through one manufacturer.