To better understand the claim submission and processing procedure, you should understand the terms and abbreviations used by most insurance carriers. The most common are:
• ICD-9 CODE (International Classification of Diseases, 9th Edition). This is the coding system used to
identify your illness. All claims submitted to your insurance carrier will require the correct code. Carriers will
not pay your claim if this code is not provided.
• CPT CODE (Current Procedural Terminology). This is the coding system used to identify medical, surgical
and diagnostic services rendered by your physician. It is used by most insurance carriers to identify what
services were performed. Claims are paid using these codes.
• Deductible. This is the amount you have to pay before your insurance starts paying the rest. Only medical
care received as a benefit under your policy is calculated against your deductible. Non-covered benefits that
you pay yourself do not count against your deductible.
• Co-payment. This refers to the amount of your bill that you are responsible for. The co-payment is usually a
specific dollar amount rather than a percentage of the bill. Prescription drug programs, for example, often have
a co-payment, usually a fixed dollar amount per prescription.
• Co-Insurance. This is the percentage of the bill you are responsible for after you have met your deductible. If
your policy has a $100 deductible and a 20 percent co-insurance, for example, you would pay your $100
deductible and 20 percent of all covered expenses. You are also responsible for all services not covered by
