Here at ZocDoc, we get a lot of questions about health insurance. It’s one of the cornerstones of our country’s health care system, but understanding it can be a challenge. That’s why we’re pleased to bring you the ZocDoc Insurance 101 series. Today we’ll help you get a little better acquainted with the different types of pay arrangements and their limits:

One word that gets thrown around a lot is ‘claim’? What exactly is a claim? A claim is basically a bill that you submit to your insurance company for money they owe you. It’s a request, under the terms of your insurance policy, that your insurer cover certain medical costs. Usually, filing a claim means submitting a claims form (provided by your insurer) along with evidence of your medical costs (a hospital bill) and proof that you’ve paid your share (receipts).

Okay, so let’s say I file a claim. What is my ‘out-of-pocket maximum’? Last time, you may recall, we discussed your deductible, co-pay, and coinsurance. Those are types of payments you have to make out-of-pocket – from your own funds, with no reimbursement. Well, the out-of-pocket maximum is an important little number, because it specifies the most of those costs you have to cough up. If your out-of-pocket maximum in a year is $4000, then $4000 is the most you’ll have to pay. After that, your insurer has to cover the rest.

Is that similar to a ‘stop-loss’ provision? Yes! In your insurance policy, the stop-loss clause establishes your out-of-pocket maximum – the most you’ll have to pay in a given year or course of treatment.

What does it mean when an insurance company says my bill isn’t ‘UCR’? The term ‘UCR’ is short for ‘Usual, Customary, and Reasonable’. For any given medical procedure or treatment, insurance companies have to decide on an acceptable cost. So in New York City, insurance companies might say that $200 is the UCR cost to have a cavity filled. If you file a claim for more than $200, your insurance company might balk, saying the procedure cost too much – it was beyond what they consider UCR. (If a health care provider’s bill is over UCR, you can sometimes appeal to them to reduce the bill.)

How do I find a doctor who accepts my insurance plan? It used to be tough! Now, it’s as easy as going to ZocDoc and searching by your insurance plan. We’ll give you a list of all the dentists or doctors in your area that take your insurance. Making the healthcare industry easier to navigate is something your friends at ZocDoc work for every day.