Health insurance glossary

Explanation of Benefits (EOB)

A document from your insurer explaining how a claim was processed and what was paid or denied.

Prior Authorization

Advance approval from your insurer required before receiving certain services.

ERISA (Employee Retirement Income Security Act)

Federal law governing most employer-sponsored health plans, including their appeal requirements.

CARC Code (Claim Adjustment Reason Code)

A standardized code on your EOB that identifies the specific reason your insurance claim was adjusted or denied.

External Review

An independent review of an insurance denial by a third party whose decision is binding on the insurer.