How long do claims take to process?
Most claims process within 30-60 days, though complex cases may take longer.
What is coordination of benefits?
When two insurers determine which plan pays first and how remaining balances are handled.
What is a deductible?
Your deductible is the amount you must pay out-of-pocket each year before your insurance begins paying for covered services.
What is coinsurance?
Coinsurance is the percentage of the allowed amount you pay after your deductible has been met.
What is an out-of-pocket maximum?
This is the most you will pay for covered services during a plan year. After you reach it, insurance typically pays 100% of covered services.
Why do I receive multiple bills for one surgery?
Each provider bills separately – your surgeon, anesthesiologist, hospital, pathology lab, and possibly assistant surgeon all submit individual claims.
What is prior authorization?
Prior authorization is approval from your insurance company confirming the procedure meets medical necessity guidelines before surgery.
Does prior authorization guarantee payment?
No. It confirms eligibility under medical guidelines, but payment still depends on correct billing and your active coverage at the time of service.
What is an Explanation of Benefits (EOB)?
An EOB is a summary from your insurance company showing what was billed, what was allowed, what they paid, and what you may owe. It is not a bill.
What does “allowed amount” mean?
The allowed amount is the negotiated rate between your insurance company and the provider. It is usually lower than the billed charge.