Here are definitions of some of the terms that are used throughout the site.

ABMS (American Board of Medical Specialties): The ABMS is the umbrella organization under which the 24 certifying medical boards function in the United States. ABMS's main purpose is to coordinate information regarding medical specialties and certification in medicine, and to disseminate such information to the public, government and the medical profession.

Abdominoplasty (Tummy Tuck): Abdominoplasty is surgery to tighten abdominal muscles and skin, and is often performed after multiple pregnancies or weight loss. A "mini" tummy tuck addresses muscle weakness and skin laxity below the navel. The amount of muscle and skin weakening will determine whether a full or modified (mini) abdominoplasty is warranted.

Acceptance of New Patients : Designates who the physician is accepting for initial appointments. How information is collected: Information is indicated by the provider at upon initial contracting or renewal of contract. When is the information updated: When the provider updates BCBSNC to a change in status. Limitations: Reliance on provider updates

Appointments available for current patients only: This provider is only accepting current patients or previous patients with a still-active chart. Please call the provider for verification. How information is collected: Information is indicated by the provider at upon initial contracting or renewal of contract. When is the information updated: When the provider updates BCBSNC to a change in status.

Accreditation: The formal evaluation of an organization according to accepted criteria or standards. Accreditation may be done by a professional society, a non-governmental body, or a governmental agency. NCQA accreditation is a nationally recognized evaluation that purchasers, regulators, and consumers can use to assess managed care plans. How information is collected: As noted on Application and Copy of Accreditation certificate with effective dates. When is the information updated: Time of recredentialing or when notified by the Facility.

Actual charge: The amount a doctor or other healthcare provider actually bills a patient. The actual charge may be different from the allowable charge. This means your health plan may only cover a portion of what your doctor charges you and you will be asked to pay the difference. For example, your doctor may charge $40 for an office visit - this is the actual charge. However, your health plan may only allow for $30 visit. Therefore, you would be required to pay the difference of $10.

Acupressure: A massage technique which stimulates pressure points on the surface of the body to promote circulation, derived from ancient Chinese methods. See also Therapeutic Massage.

Acupuncture: A technique of oriental medicine performed only by licensed health care providers. Fine needles are inserted into the body at specific points to induce anesthesia, relieve pain, or to treat other various disorders.

Adjudication: The process of determining the reimbursement applicable to a particular claim.

Aesthetic Surgery: See Cosmetic Surgery

Aesthetician: An aesthetician is a non-medical practitioner who specializes in the education, preventive care and treatment of the skin, by offering non-invasive treatments, such as facials, light chemical peels, exfoliation, make-up application and other skin care therapies.

Agent: A person or organization who is authorized by an insurer to act on its behalf to negotiate, sell, and service managed care contracts.

Alexander Technique: A somatic education method that develops and maintains the alignment of the head, neck and back in order to reduce unnecessary strains on the body, improve posture and overall health.

Allergy Treatment: Allergy testing, allergy immunotherapy, and allergy injection services indicated by standard medical practice.

Allowable Charge: The maximum fee that a health plan will reimburse a provider for a given service.

Allowed Amount: The charge that BCBSNC determines is reasonable for covered services provided to a member. This may be established in accordance with an agreement between the provider and BCBSNC.

Alternative medicine practitioner: A professional who practices acupuncture; bodywork; chiropractic; cooking instruction; fitness instruction; massage; mind/body relaxation; nutritional counseling; somatic education; Qi Gong; Tai Chi; or Yoga who may or may not be licensed or certified in the state of practice. Alternative medicine services are not a covered benefit, but BCBSNC members get discounts through contracted practitioners.

Alternative Medicine: Alternative medicine includes a variety of therapies that work to increase wellness, prevent illness and address existing symptoms and conditions. Increasingly, many medical professionals regard alternative medicine as complementary to conventional medicine. In fact, it is sometimes referred to as complementary and alternative medicine

Ambulatory Care: Medical services that are provided on an outpatient (non-hospitalized) basis, including the office setting. Generally synonymous with outpatient; however, some outpatient services may be excluded.

Ambulatory Surgery: See Outpatient Surgery.

Ambulatory Surgery Center: A non-hospital facility with an organized staff of doctors, which is licensed or certified in the state where located, and which:

• Has permanent facilities and equipment for the primary purpose of performing surgical procedures on an outpatient basis.
• Provides nursing services and treatment by or under the supervision of doctors whenever the patient is in the facility.
• Does not provide inpatient accommodations.
• Is no other than incidentally, a facility used as an office or clinic for the private practice of a doctor or other provider.

Ancillary Services: Facility services exclusive of room and board, such as supplies and laboratory tests provided in the following settings: Homecare, Durable Medical Equipment (DME), Ambulatory Surgical Centers (ASC), Home Infusion, Hospice, Skilled Nursing Facility (SNF), Mobile Lithotripsy, Sleep Centers, and Dialysis.

Antioxidant: Substances that render free radicals incapable of doing damage. Some of the most important antioxidants are Vitamins C and E, and Beta Carotene.

Appeals: A process used by a patient to request the health plan reconsider a previous authorization or claim decision.

Arm Lift (Brachioplasty): Brachioplasty is a procedure also known as "arm tightening" to eliminate excess skin from the upper arm. This condition can occur as a result of age or significant weight loss. Although the arm contour is greatly improved, this procedure leaves a permanent and noticeable scar. The scarring is a significant factor when considering this procedure.

Astigmatism: Results from an abnormally shaped cornea. Light rays are refracted unequally causing images viewed at most distances to appear ghost-like or blurry.

Authorization: See Pre-Authorization.

Authorized Signatory: The person who has legal authority to enter into contracts on behalf of the provider group identified.

Average Cost: Total doctor and/or hospital charges divided by total cases.

Average Hospital Days: Total number of days divided by the number of admissions.