EOB: Explanation of benefits. This is what you will get from your insurance carrier showing what they paid to your doctor's office, why they paid it, and an estimate of what you may owe your doctor. It is not a bill.
Allowable fees or Contracted rate: This is the amount your insurance carrier agrees to pay your doctor or hospital for medical services. Just because they bill out $800 worth of services doesn't mean that's what they will get paid.
ICD-9 codes: These are diagnosis codes (ie. what's wrong with you) submitted on insurance claims.
Example: 719.46 is knee pain
CPT codes: These are procedure codes (ie. what the doctor did) submitted on insurance claims.
Example: 99203 is a new patient office visit 30 minute appointment
Questions? Comments?
email me at deargabbyinsurance@yahoo.com
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