A patient estimate and a benefit summary for the specific procedure: coverage status for the CPT code, network tier for this provider at this location, which deductible applies and the remaining amount, copay or coinsurance for the code, visit limits with the count used, and whether prior authorization is required. The summary is written for staff and patients alike.
The estimate is produced by applying the practice's fee schedule to those benefits, so it is a collectible number rather than a set of percentages. The benefit summary doubles as the patient's financial responsibility sheet, customized to the organization. Both are delivered inside the systems staff already use.
