Health Insurance Glossary

A group of multi-specialty medical groups and individual practice doctors that are contracted to provide services to members of a health plan.
Network Provider
A medical provider who has contracted with a health plan as a participating provider.
Non-Allowed Amount
The amount that is not eligible for benefits. Refer to the remarks area for an explanation of the 3-digit code that appears on this line.
Non-Participating Provider
A medical/ dental provider who has not contracted with a particular health plan within its participating provider network. The member is responsible for the total charge for services rendered. See Participating Provider.
Not Medically Necessary
Describes the use of a service or supply which does not meet the criteria for determining medical necessity. See Medically Necessary.