Patient Benefits- Understanding Your Benefits (eob) Form
An EOB is also known as a claims statement
An EOB is also known as a claims statement. It's not a bill. Rather, it's an attempt by the insurance company to spell out your medical costs in an itemized manner. This is done so everyone- the patient, doctors and the insurance company gets the total picture.
Medical billers report that assisting patients in understanding their EOB is one of the main aspects of their job. They receive numerous calls regarding bills. And with the national association Medical Billing Advocates of America reporting that medical errors exist in 8 out of 10 hospital bills they check, it's no wonder.
Each medical biller uses their own form but they contain common elements. Following is a general guide that will apply to most EOB forms:
- Date of Service: This will be the actual date the service, procedure or test was performed
- Place of Service/Service Provider: The place you went for the service and the provider will be listed here. It could be a hospital, clinic, medical equipment provider, doctor's office, etc.
- Service Provided: This field may be confusing. It usually contains abbreviations and code numbers that may or may not be reflected in your policy or insurance company website. Some EOB's list the common abbreviations on the back of the form so you can check there first.
- Claim or Charge Amount: The amount here is the price the provider charges for this service
- Allowed Amount: This is the amount of money your insurance plan has indicated they'll pay for the service under the terms of their contract with the provider. The amount will reflect whether or not you used an in-network or out-of-network provider. An out-of-network provider may mean that no amount or only a partial amount is allowed.
- Patient Responsibility: If you're wondering how much you have to pay out of pocket, this is the place where that amount will be. Your insurance will pay the difference between the allowed and the patient responsibility amounts.
Form names and format may vary. Codes used may also be different from one medical biller to another but this is the basic information you'll see.
In addition, you may see the following:
- Deductible Amount: This is the amount you pay out of pocket before the insurance kicks in. So, if you have a $2500 deductible, you'll have to pay that amount first. For example, if your service, treatment or test cost $1200 you may have to pay everything depending on if the treatment is subject to the deductible. (Note: Some treatments, like an annual physical, may be paid 100 percent for an annual visit and not be subject to a deductible.)
- Copayment- - Copayments or copays are an amount you have to pay at the point of service. For example, you might have a $25 copay for doctor's visit. This means that when you get to the doctor's office you'll have to pay $25 out of your pocket before you can get treated.
- Coinsurance- This is the payment you'll share with the insurance company after the deductible is met. For example, your coinsurance might be stated that the insurance company will pay 80 percent of the next $10,000 of coverage after the deductible. You'd be responsible for the remaining 20 percent.
Look at your EOB carefully and don't hesitate to contact your biller for any clarification.
by: Ronald McLaughlin
Patient Benefits- Understanding Your Benefits (eob) Form Methods to Spot a nicely-Made Hermes Bag Putting on a Live Event - 3 Things to Think About to Make Sure Your Workshop Or Seminar is a Success Italy Guide To Venice Finding Suitable Gym Instructor Courses The Charm Of A Chenille Bedspread A Basic Understanding Of How A Wood Burning Stove Pipe Functions Importance of Safes Weapons Of The Aztec Civilization Why Do Accidents Happen? Develop Resistance To Conjunctivitis, Naturally What Constitues A Successful Balance Facility Various Kinds of Fireproof Safes