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- what charges were applied toward your deductible. If your physician is a Medicare provider, the check will be
- sent directly to his or her office. You will need this explanation of Medicare benefits in order for your
- secondary insurance company to pay your claim.
- • UCR (Usual, Customary and Reasonable). This is the fee determined by your insurance carrier to be the usual
- fee charged for the same service by the average provider with similar training in your geographic area. This
- may be different than the fee your physician charges.
- • Pre-Authorization. This is a requirement by your insurance carrier that certain services be authorized before
- the services are rendered. If your insurance contains this requirement, make sure your physician's office is
- aware of it.
- • Superbill. This is a standard itemized "checklist of services" in widespread use. It will contain all the required
- codes (CPT and ICD-9) that will enable you to submit your claim.
- • C.O.B. (Coordination of Benefits). When you are enrolled in two separate insurance plans, those plans will
- coordinate their benefits so that your claim is paid at no more than 100 percent of the covered benefits. If you
- have more than one insurance plan, make sure you notify your physician's office so the office can submit both
- claims for you.
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