Your EOB is the only way to know which medical services your health insurance plan covered, and you’ll need it if you were denied coverage or want to negotiate your bill. If you don’t think it was, or you’re simply confused about the details, write down every question you have and call your insurer’s customer support line to ask. In addition to the medical bill, you’ll want to have some other paperwork handy, starting with your insurance plan summary of benefits. This information may be different than what you see when you visit a financial institution, service provider or specific product’s site. Deductible: the amount that you pay before your plan covers a larger portion of your bills. After a hospital stay or outpatient visit, you may get several bills and at least one statement that says “not a bill.” This is your explanation of benefits, or EOB. If you still think you’ve been billed unfairly, you may want to try to negotiate charges or ask an advocate like Welch to audit the medical bill and EOB for errors. The EOB is sent to the patient and the provider to show how the claim processed. Get instant quotes for individual health insurance plans. If anything is amiss — the payment allowances aren’t correct, for example, or a procedure that should have approved was denied — then you need to appeal the claim and provide medical records and other necessary documentation to support your claim. In addition to the information above, there will be other numbers, terms and codes on the EOB that may be unfamiliar. Here’s how to make sure your health insurance coverage was applied correctly. On the other hand, if you think your insurance was billed incorrectly, call your hospital or provider first and request a copy of your medical records, which should detail all services you’re being billed for. Any services that aren’t covered by your health plan, as outlined in your plan summary, don’t count toward your deductible. Charge amount, or billed amount: a price for each medical service or treatment, or what you would have been charged if you didn’t have health insurance. Take a look at your plan’s sample before you start to read your own. An EOB generally contains the details explaining how the claim was processed, although some payer EOBs show only the total claim amount, along with the total provider write off, and the total allowance. It is simply a statement of the medical services you received and details on how you and your plan will share costs. Start here to maximize your rewards or minimize your interest rates. Is my Explanation of Benefits a bill? In an ideal world, your provider submits a claim, the visit is billed correctly, all providers are in-network, and you are only billed for the amount your EOB says is “due from patient.”. This may influence which products we write about and where and how the product appears on a page. For each medical bill you receive, you should receive an explanation from your insurer, though sometimes more than one medical bill is reflected on an EOB. Explanation of Medical Benefits (EOB) Versus a Bill Why has your physician chosen Bako Pathology Services? Your copays and coinsurance should be clearly listed for each covered service on your plan summary. Here’s What to Know, HSA vs. FSA: Differences and How to Choose, Open Enrollment at Work: Get Ready to Get Choosy, How to Choose the Right Amount for Your FSA in 2018, Choosing Between a Low- or High-Deductible Health Plan, Health Insurers Ease Rules for Harvey Victims, Here’s the Penalty for Not Having Health Insurance. How to Deal with Prior Authorization in Medical Billing, Medical Terminology: Respiratory Root Words, How to Introduce Your Business in a Letter. We work closely with your Doctor to see that he/she is given all the information that is needed to provide optimal medical or surgical care. Look at this statement carefully and make sure it is correct. Remark or reason code: When a charge isn’t paid by your insurer, the explanation of benefits should state a reason, such as an out-of-network physician, a noncovered service or an unmet deductible. Place of service: This may or may not be listed on your EOB, along with a “location” code. After a hospital stay or outpatient visit, you may get several bills and at least one statement that says “not a bill.” This is your explanation of benefits, or EOB.… This information may be different than what you see when you visit a financial institution, service provider or specific product’s site. The EOB is sent to the patient and the provider to show how the claim processed. These documents are fairly standard among insurance companies. If a line is blank for this column, your insurance probably doesn’t cover this service. Due from patient: the amount that you are responsible for paying to the provider. As a biller/coder, you want to review this documentation to verify that the claim has processed and paid correctly. Please help us keep our site clean and safe by following our, The difference between term and whole life insurance, How medical conditions affect your life insurance rate, Check Your Health Coverage With an Explanation of Benefits. These codes are often in place because your plan may only cover certain procedures if they’re performed in a specific setting, such as a hospital or urgent care facility. It shows how much you may owe, the amount that was billed, and your member rate. 28, Dec 2011. If you find discrepancies with your credit score or information from your credit report, please contact TransUnion® directly. The point of reading your EOB is to make sure the insurance claim was processed correctly for your visit. If you find discrepancies with your credit score or information from your credit report, please contact TransUnion® directly. Copayment and coinsurance: the amount you pay for each service, whether as a set fee (copay) or percentage (coinsurance). Your health plan’s online customer portal also may have a sample explanation of benefits available; most major insurers do. Take the time to go through each charge separately to ensure your coverage was correct. How to read an EOB. Charges not covered: This is the difference between the charge and allowed amount. Then, use a tool like FairHealth to find out what reasonable charges are for the services you received. Payment amount: the dollar amount that your insurance company agrees to pay for the visit. Our opinions are our own. In most cases, it has made the payment before you receive your EOB. When this happens, it is up to the payment poster, or designee, to break the payment out to show the detail by line. Since EOB styles differ among companies, the sample your insurer provides is the best way to understand any confusing sections on your EOB. Property and Casualty insurance services offered through NerdWallet Insurance Services, Inc.: Licenses, NerdWallet Compare, Inc. NMLS ID# 1617539, NMLS Consumer AccessLicenses and Disclosures, California: California Finance Lender loans arranged pursuant to Department of Business Oversight Finance Lenders License #60DBO-74812. Here are the kinds of postings you see on the EOB for every CPT code listed: Amount of the procedure before any discounts are applied, Amount that the patient is responsible for, How much the contract allows for the procedure, The type and amount of any discounts that apply, The final amount of the reimbursement after all discounts, deductibles, and so on are applied. As a coder, you need to pay attention to the details on this form to make sure the provider received the reimbursement to which she was entitled. Families, 2007-2010, Tracking Report No. In some cases, this may be the only amount you’re responsible for, and for outpatient care, you probably paid it at the visit. At first sight, it might look like a bunch of numbers and nonsense to you, and you may even be tempted to throw it away. Compare the codes/descriptions of services from your EOB and your medical bill and make sure that they match and look for duplicate Remember that EOBs state the costs associated with your care, but they are not bills. Explanation of Benefits (EOB) - This is not a bill This statement is called your EOB. Compare your summary of benefits with what your insurance actually paid. Here are some things to look for: That the right payment allowances were applied, That discounts were applied appropriately, That no procedures were improperly denied, If no payment was received, whether it was due to the entire amount being applied to the patient’s deductible, the claim being denied, or some other reason. Patient Advocate Foundation, Understanding Your Explanation of Benefits, 2010. Center for Studying Health System Change, Medical Bill Problems Steady for U.S. Lacie Glover is a staff writer at NerdWallet, a personal finance website. Medical Billing Advocates of America, If you think you are paying too much for health care you are right, 2011. But a lot can go wrong. When evaluating offers, please review the financial institution’s Terms and Conditions. Sometimes more than one EOB applies to a single bill. Mainly, these will reflect dollar amounts charged and paid for your medical services.
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