An insurance claims department compares the fee the doctor charges with the benefits provided by the patient's health plan. This is called the ____.

A) payment of benefits
B) review of medical necessity
C) explanation of benefits
D) review for allowable benefits
E) payment and remittance advice

Health Plan

A contract or policy that provides financial coverage for medical services, often provided by employers or purchased by individuals.

Insurance Claims

Requests made by policyholders to insurance companies for payment of benefits due under their insurance policies, following loss or damage.

Medical Necessity

A criterion used by healthcare providers and insurance companies to determine if a treatment or procedure is essential for diagnosis or treatment.