1. Medical care that has not yet been accepted as standard care in the practice of medicine. 2. Any medical care that needs federal or other governmental agency approval that was not given at the time the care was provided. Also called investigative care .

Medical services, supplies, treatments, or drug therapies still in a trial stage, determined by the insurance plan not to be generally accepted as standard care in the practice of medicine, and not effective in treating the illness for which their use is intended. Also called unproved procedures .

Insurance company that accepts certain types of risks considered uninsurable according to the insurer’s normal underwriting guidelines.

A document or voucher detailing services billed and describing payment determinations that is sent to the insured and provider. It is known in Medicare, Medicaid, and some other programs as a remittance advice (RA) ; formerly known as Explanation of Medicare Benefits (EOMB) . In the TRICARE program, it is called a summary payment voucher . A payment check is usually attached or a part of the EOB. The EOB should include details of the claim(s) submitted, payment(s), deductible status, and each insured’s responsibility to the provider. See also electronic remittance notice (ERN), remittance advice (RA) , and Medicare remittance notice (MRN) .

Insurance booklet or section in the insurance policy that summarizes provisions (benefits and coverages) under an insurance policy. Also called a benefit booklet, benefit plan summary , or summary plan description .

Additional information about items referenced by footnotes or symbols on an explanation of benefits (EOB) document.

Verbal or written agreement.