Have you ever received an Explanation of Benefits after submitting a medical bill?

If so, you may have had questions about what it means and how it works. An EOB is a notification sent to you after processing a claim with your insurance provider. It gives you an overview of the total charges on your bill, the services used, and the amount paid by your insurance provider.

Understanding an EOB is the first step in managing your medical expenses, so it’s important to be familiar with what the document contains and how it works. In this article, we’ll take a closer look at the explanation of benefits and explain how it plays a role in the medical billing process.

What is an Explanation of Benefits?

This is a summary of the services you received and the costs associated with those services. It also indicates the amount your insurance company paid, if any. The explanation of benefits is a useful tool for medical billing, as it contains information that can help you understand your medical expenses.

It can also help you determine if the services you received were covered by your insurance and at what cost-sharing level. You may receive an EOB from your insurance provider at the time of service, after a claim has been processed, or after you submit a claim. An explanation of benefits is typically sent as a paper document, though electronic versions are available.

An explanation of benefits is not the same thing as an explanation of benefits () notice or a notice of coverage determination (NOCD).

What an explanation of benefits includes:

It includes a variety of information, including details about the services provided, any applicable cost-sharing, the amount your insurance provider paid, and your account balance.

The EOB will also include your patient’s plan identification code and a provider’s billing number. The explanation of benefits will indicate the specific type of insurance you have (i.e. Blue Cross, Medicare, etc.) and provide your plan identification number.

Overview of the medical billing process

After a service has been provided, the provider will submit a claim for payment to the patient’s insurer. The claim will include details about the services provided, the provider’s billing code, and the amount the provider would like to be paid for the services. The insurer will then review the claim to determine if it will pay for any portion of the services.

If so, it will send the details of the claim and the amount it will pay to the provider. The provider will then send the claim details and the amount it would like to be paid to the patient. If the patient has insurance, they will also receive the insurer’s decision and details of the amount it would pay.

How an EOB relates to the medical billing process

it is generated through the same process as the claim itself. It therefore contains the same information. The claim may be processed before the EOB is generated, or it may be sent at the same time as the claim. The provider may send the explanation of benefits to the patient before they receive the claim details from the insurer.

If this happens, the patient will have to wait until the insurer sends their decision before, they can determine how much they owe their provider. The EOB contains information that can help you understand how the claim was processed and how much the insurer will pay. This can help you determine if you will be responsible for covering the cost of the services.

How to read an EOB

The first line on the bill will indicate the amount the insurer paid towards the claim. This is referred to as the “amount paid.” The amount paid is not necessarily equal to the charges on the patient’s bill. This is important because it’s the amount you will have to pay your provider unless you have additional insurance or a discount. The next section of the EOB indicates how much the insurer expects the patient to pay.

This is called the “amount owed.” The last section of the explanation of benefits shows how much the patient has remaining in coverage for the period being billed. This is referred to as the “co-pay remaining.” The last line indicates the patient’s “account balance.”

How to use an explanation of benefits to manage medical expenses

It is a good tool for managing your medical expenses. If you are unsure how much you will be responsible for covering the costs, you can use the information on the EOB to determine if you have additional insurance or if you qualify for a discount.

For example, if you have a $1,000 bill and the amount paid by your insurer is $600, you will have to pay the remainder ($400). However, if you have a $1,000 deductible, you will have to pay the full amount. You can use the information on the EOB to determine if you have additional insurance or if you qualify for a discount. If you have additional insurance and the amount you owe has been covered, you will not have to pay your provider.

What to do if you have questions about an explanation of benefits?

If you don’t understand the details on your bill, you may want to ask your provider for more information. The provider should be able to explain how the details on your EOB were calculated and help you understand how the charges on your medical bill were determined.

If you have follow-up questions, your provider may offer to discuss them over the phone, or they may refer you to the plan administrator. The plan administrator is the company that manages the claims for your insurer. For example, if you want to know why the amount paid was less than the charges on your bill, the plan administrator may be able to provide the details of the claim that were used to generate the EOB.

Examples:

A basic example of an EOB includes charges, benefits paid, and the amount due after the benefits have been deducted. This information is broken down into three separate sections. The first section details the charges.

The second section includes the amount paid by the insurer. The third section shows any remaining balance, the amount due, and the plan code.

Tips:

  • Before you receive an EOB, consider how much you would like to pay for the medical services you receive. You can use this amount as a guideline for how much you want to pay your provider.
  • Talk to your provider about how the charges on your medical bill were calculated. This can help you determine how much you want to pay for the medical services.
  • Your insurer may change the amount it pays, which may change the amount you owe. If you receive an bill that doesn’t match the charges on your medical bill, double-check your coverage.
  • If you receive an bill for a service, you believe should be covered, you can appeal your insurer’s decision.

An EOB is a key document in the medical billing process. It provides patients with information about the charges on their medical bills and the amount covered by their insurance.

The EOB can also help you determine if you have additional insurance or qualify for a discount. If you receive an EOB, be sure to review it to understand how the charges are calculated and what you will be responsible for paying. With this information, you can better manage your medical expenses.

author avatar

Isaac Smith

My name isaac and I am a revenue cycle management strategist with more than 10 years of experience. I completed my Bachelor in Medical and Health Services Management from Kean University and have worked extensively in the field of healthcare.

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