Thursday, August 18, 2011

Understanding your Explanation of Benefits (EOB)

Patients sometimes receive a bill from us and don't understand why they're getting one at all, or have questions about how their insurance paid a claim. (See also: When Claims Don't Get Paid). They may not realize they have a deductible to satisfy before their claims are paid in full, or that they have a co-pay. One question I usually ask them is whether they've reviewed the Explanation of Benefits (EOB) that they receive from their insurer. When a claim is considered by your insurance company, an EOB is sent to the patient to show how a claim is paid (or not paid), and we get a copy at the office along with a check (if there is one). Patients often disregard these, especially when they see "NOT A BILL" across the top of it! However, you should always pay close attention to these. Everybody makes mistakes, from the way the claim was billed at our office, to the way it was paid by the insurance. We are always happy to help patients review these, realizing they can be confusing.

The EOB usually consists of several columns:
Patient Name
Date of Service
Procedure: This could just be a code representing an office visit or procedure, sometimes accompanied by a brief description
Charges: This would be the actual charge for the procedure(s) from our office
Allowed Amount: This is the amount the insurance company has contracted to pay us for the specified procedure(s)
Co-pay/Deductible: Sometimes also called the Patient Responsibility, representing what the patient owes after the insurance has paid and discounted the bill
Contractual Adjustment: Not always included, but represents the amount the doctor's office has agreed to discount through the contract with the insurance
Amount Paid: Total amount paid to the doctor
Sometimes there are codes appended to any of these columns; explanations of what the codes are for are usually at the bottom of the EOB.

The Patient Responsibility is the only amount you should have to pay. We are not allowed to bill you more than the insurance has contracted for our services.

If you ever have any questions about your bill, or your EOB please call us! We'll be happy to help.

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