access activities of daily living allowed expenses ambulatory care ancillary services average length of stay balance billing benefits capitation case management case manager claim co insurance co payment coverage covered expenses customary charge deductable diagnosis related groups exclusive provider organization experimental procedures fee for service health maintenance organization inpatient care managed care managed care plan maximum out of pocket medicaid medicare open enrollment outpatient care participating provider physician hospital organization point of service (pos) plan preauthorization preexisting conditions preferred provider organization: premium point of service primary care physician private insurance provider reasonable charge referral second opinion single payer subscriber subsidies specialist tertiary care usual charge utilization review