CPB (Certified Professional Biller) Certification Practice Exam

What term means the patient is not responsible for paying for what the insurance plan denies?

1. Hold Harmless Clause

2. Guilty Payment Rule

3. Joint Ownership Agreement

4. Liability Mandate Provision

The correct answer is: Hold Harmless Clause

The correct term that indicates the patient is not responsible for paying for what the insurance plan denies is the Hold Harmless Clause. This clause is often included in contracts between healthcare providers and insurance companies to protect patients from being billed for amounts not covered by their insurance. It ensures that if an insurance claim is denied, the financial responsibility does not fall on the patient, fostering a sense of security for individuals seeking care. The other terms listed do not pertain to this specific concept. For instance, the Guilty Payment Rule does not relate to insurance denial but rather involves acknowledging responsibility for payments in different contexts. Joint Ownership Agreement typically refers to arrangements regarding shared property and is not relevant to billing or insurance coverage. The Liability Mandate Provision does not exist as a recognized term in the insurance field and does not provide protection against billing for denied claims. Thus, the Hold Harmless Clause is the accurate terminology for the scenario presented.