Medical Billing
Knowledge Center

The maximum amount your insurance will pay for a covered service. Providers who accept your insurance agree to this amount as full payment, though you may still owe copays, coinsurance, or deductibles.

When a provider bills you for the difference between their charge and the allowed amount. This is prohibited in many situations under the No Surprises Act, especially for emergency services and out-of-network providers at in-network facilities.

A 5-digit code assigned to every medical service and procedure. These codes tell insurance companies what was done during your visit. The same service should always have the same code.

The amount you must pay out-of-pocket each year before your insurance begins covering services. Not all services count toward the deductible — preventive care is often covered before you meet it.

A statement from your insurance company showing what they paid, what they didn't pay, and what you owe. This is NOT a bill — it's an explanation of how your benefits were applied.

International Classification of Diseases code — the diagnosis code that explains WHY you received care. These codes must match the procedure codes for insurance to process your claim correctly.

A federal law (effective January 2022) that protects patients from surprise medical bills. It limits balance billing for emergency services and for certain out-of-network providers at in-network facilities.

Approval from your insurance company before you receive certain services, procedures, or prescriptions. If you don't get prior authorization when required, insurance may deny payment.