What is a Explanation of Benefits (EOB)?
The Explanation of Benefits (EOB) document is a summary of the claims your health care providers sent to your health plan for health services provided to you and other family members on the plan. Your EOB is not a bill. It is a statement that shows what health services you received, what claims your health plan paid, and what you may still owe to a health care provider
WHAT information EOB included
The Explanation of Benefits (EOB) is completed. The (EOB) form or report is a statement telling the patient or provider how the insurance company determined its share of the reimbursement. The report includes the following:
a). A list of all procedures and charges submitted on the claim form.
b). A list of any procedure submitted but not considered a benefit of the policy.
c). A list of all the allowed charges for each covered procedures.
d). The amount of the patient deductible, if any, subtracted from the total allowed charges.
e). The patient’s financial responsibility for cost sharing (co-payment for this claim)
f).The total amount payable by the insurance company on this claim.
Your Explanation of Benefits (EOB) may help you better understand your health care costs The name of the member/ patient.
A detailed list of the services performed. A breakdown of how much your plan paid for each service. Your deductible, copay, coinsurance and the total you may owe
your provider.
More details on why a claim was — or was not — paid.
A summary of how much you had paid toward your deductible and out-of-pocket maximum at the time the claim was processed.
Definitions that may help you better understand the EOB.
Review your EOBs. Log in to myuhc.com® to check on claims and see your EOBs. After you visit a provider, your health plan may send you an Explanation of Benefits. It gives you important details about what your plan covers and what you may owe.
EOB: Explanation of Benefits: Medical biller responsibility
When an insurance company processes a claim for health benefits or a claim for a provider contract, it produces a report of how the claim was processed. The claim will be (a) paid, (b) denied or (c) pended. When paid, the medical biller checks the EOB to determine if the claim was paid correctly either per the provider’s contract or per the patient’s contract. Sometimes a claim was sent with multiple procedures but some were left off the EOB. The biller should check to make sure all CPT codes submitted are on the EOB. The biller should check the allowed amount.
Some insurance companies may have an allowed amount that is less than the billed charges. If the provider is non-par, any allowed amount that is less than billed charges should be unacceptable. However, the insurance may pay the non-par claim at the amount pursuant t their contract with their member. However, the member would usually be required to pay the difference between the insurance company payment and billed charges. If the claim is to Medicare or Medicare, the allowed amount would be the Medicare/Medicaid allowed amount. One thing the billr can do is create a cheat sheet in spreadsheet showing the CPT codes used by the provider. The cheat sheet will list the charges, the Medicare and Medicaid allowable amounts. And any provider contract amounts. I also like to add State workers compensation fees payable per CPT code. This way you have easy access to payment amounts due to the provider by contract, workers comp, Medicare and Medicaid. If there are amounts less than billed charges, any amounts applied to the deductible or coinsurance, the EOB will show this as well as have remark codes and remark code descriptions. For example, lets say you see remark code X20.
On the EOB you may see X20: Allowed amount is based on contract allowed amount. Sometimes the remarks don’t have any sane meaning. You may have to contact the insurance company and ask them what that remark code means. If the provider is non-par watch out for remarks that mention contract discounts or discounts applied to benefit the member. To be honest, the only one being benefitted by a discount is the insurance company, not the member. The insurance company may have sent a facsimile or phone call to the provider asking the provider to accept a discount to the payment. If this happened, you should have been informed of any interim agreements made on individual discounts.
The Explanation of Benefits (EOB) document is a summary of the claims your health care providers sent to your health plan for health services provided to you and other family members on the plan. Your EOB is not a bill. It is a statement that shows what health services you received, what claims your health plan paid, and what you may still owe to a health care provider
WHAT information EOB included
The Explanation of Benefits (EOB) is completed. The (EOB) form or report is a statement telling the patient or provider how the insurance company determined its share of the reimbursement. The report includes the following:
a). A list of all procedures and charges submitted on the claim form.
b). A list of any procedure submitted but not considered a benefit of the policy.
c). A list of all the allowed charges for each covered procedures.
d). The amount of the patient deductible, if any, subtracted from the total allowed charges.
e). The patient’s financial responsibility for cost sharing (co-payment for this claim)
f).The total amount payable by the insurance company on this claim.
Your Explanation of Benefits (EOB) may help you better understand your health care costs The name of the member/ patient.
A detailed list of the services performed. A breakdown of how much your plan paid for each service. Your deductible, copay, coinsurance and the total you may owe
your provider.
More details on why a claim was — or was not — paid.
A summary of how much you had paid toward your deductible and out-of-pocket maximum at the time the claim was processed.
Definitions that may help you better understand the EOB.
Review your EOBs. Log in to myuhc.com® to check on claims and see your EOBs. After you visit a provider, your health plan may send you an Explanation of Benefits. It gives you important details about what your plan covers and what you may owe.
EOB: Explanation of Benefits: Medical biller responsibility
When an insurance company processes a claim for health benefits or a claim for a provider contract, it produces a report of how the claim was processed. The claim will be (a) paid, (b) denied or (c) pended. When paid, the medical biller checks the EOB to determine if the claim was paid correctly either per the provider’s contract or per the patient’s contract. Sometimes a claim was sent with multiple procedures but some were left off the EOB. The biller should check to make sure all CPT codes submitted are on the EOB. The biller should check the allowed amount.
Some insurance companies may have an allowed amount that is less than the billed charges. If the provider is non-par, any allowed amount that is less than billed charges should be unacceptable. However, the insurance may pay the non-par claim at the amount pursuant t their contract with their member. However, the member would usually be required to pay the difference between the insurance company payment and billed charges. If the claim is to Medicare or Medicare, the allowed amount would be the Medicare/Medicaid allowed amount. One thing the billr can do is create a cheat sheet in spreadsheet showing the CPT codes used by the provider. The cheat sheet will list the charges, the Medicare and Medicaid allowable amounts. And any provider contract amounts. I also like to add State workers compensation fees payable per CPT code. This way you have easy access to payment amounts due to the provider by contract, workers comp, Medicare and Medicaid. If there are amounts less than billed charges, any amounts applied to the deductible or coinsurance, the EOB will show this as well as have remark codes and remark code descriptions. For example, lets say you see remark code X20.
On the EOB you may see X20: Allowed amount is based on contract allowed amount. Sometimes the remarks don’t have any sane meaning. You may have to contact the insurance company and ask them what that remark code means. If the provider is non-par watch out for remarks that mention contract discounts or discounts applied to benefit the member. To be honest, the only one being benefitted by a discount is the insurance company, not the member. The insurance company may have sent a facsimile or phone call to the provider asking the provider to accept a discount to the payment. If this happened, you should have been informed of any interim agreements made on individual discounts.
