This is when we compare your benefits to a claim you or your doctor submitted for a health care service (example: office visit). It helps us figure out if the doctor is charging the right amount, what [..]

A signed legal document — often one that tells doctors what care decisions to make if you’re not able to speak for yourself due to an advanced health condition.

A professional whose job is to help people or companies find health coverage that’s right for them. They’re sometimes called brokers.

The amount a doctor or hospital can charge for a health care service or item they give you.

When you get care in a clinic, emergency room, hospital or surgery center and you don’t stay the night.

Health care services like lab tests, X-rays, rehab, hospice care and urgent care. They’re not necessarily performed by doctors, but help doctors diagnose or treat a health condition.

When you ask us to take another look at a decision we’ve made. For example, if we say that a certain service isn’t covered or isn’t medically necessary — but you disagree, or your doctor disagrees, an [..]

A way of resolving a dispute by agreeing to go to a third party, often instead of taking it to court.

When a doctor bills you for the difference between what they charged and the amount that’s allowed by your plan.

These are the health care services and supplies we cover for you when you’re a member. For example, if you have health care benefits with us, we help cover the cost of the health care you get.