CPB Certified Professional Biller Certification Practice Exam

What term refers to the condition where the patient is not responsible for paying for the parts that the insurance plan denies?

1. Hold Harmless Clause

2. Liability Waiver

3. Coverage Exemption

4. Benefit Limitation

The correct answer is: Hold Harmless Clause

The term that describes the situation where the patient is not responsible for payment for services that the insurance plan denies is known as a Hold Harmless Clause. This clause is a protective measure often included in contracts between healthcare providers and payers, ensuring that in cases where a claim is denied by the insurance, the patient will not be billed for the denied charges. This is fundamental in maintaining ethical billing practices and protecting patients from unexpected financial burdens due to denied claims. In contrast, a Liability Waiver typically refers to a legal waiver regarding liability for potential damages, not specifically related to payment responsibilities concerning insurance denials. Coverage Exemption may imply that certain services are not covered by a policy, but it does not address the financial responsibility of the patient in the same way as the Hold Harmless Clause does. Benefit Limitation refers to a restriction on the number of services or the amount of coverage an insurance plan will provide, which does not specifically protect the patient from being charged for denied services. Thus, the Hold Harmless Clause is crucial for ensuring that patients are not held liable for costs associated with insurance denials, promoting fair billing practices in healthcare.