Reading an Insurance Explanation of Benefits/EOB – Part 2

1) EOB for insurance may take approximately 30 days from the service start date. In the meantime, you may receive statements or monthly statements from your healthcare provider. If you received it before EOB of your insurance, keep it as a good reconciliation tool. (Sometimes we say, “This is an informational document, so this is not a bill.”) If you receive it after a claim has been paid, the statement will show the claim paid and what has been absorbed/written off by the medical institution. should reflect any adjustments/amounts It will be requested from your provider for the amount allowed. This is an invoice. (See Part 1 for how to read EOB.)

2) Then compare the health bill and insurance EOB side by side.

3) Each provider statement is specific to that provider. Each EOB is unique to that insurance plan. Familiarize yourself with her EOB on insurance and follow the steps in the Part 1 article.

4) Using two documents, the date of service, the charges billed, the amount paid by the insurance, the amount absorbed – the difference between the charges billed and the contracted/authorized amount, and the final Start reconciling outstanding amounts.

5) There are no shortcuts in this step-by-step process. You may be asked questions about the charges or services you were charged. Your insurance plan can only answer how you were paid, not whether services were performed, so be sure to call your healthcare provider for clarification.

Since it takes time from receiving the service to receiving the insurance payment, it is easy to have a “gap” in the memory of what was done.

Patient co-payments are calculated based on individual insurance coverage, so ask again to ensure clarity.

Take a look at the example below from Part 1. Use the EOB example to ensure that all totals match when compared to the provider’s statement. All totals should be expressed as shown below. In the example below, the deductible has not been met, so you owe the provider $13.

For example) medical care (patients may have received services but may not remember what was actually done.

This was a preoperative ECG interpretation made by the physician and was not known to the patient. The doctor’s name is listed for each item. ) Charged: $18 Excluded: $5 Discount/In-Network/Permit Fee $13.

A deductible of $13 applies.

The insurance paid $0 and the insurance plan paid $0 because the deductible of $3,500 was not met.

The total amount payable to the provider is $13 per in-network discounted rate/subscription rate.

The difference between the fee ($18) and the discount/allowance ($13) will be written off by the provider ($5) as part of contacting the insurance plan.

This process can be difficult, but take it one step at a time. be patient. Familiarize yourself with how your insurance plan “pays” and always ask questions when in doubt. When you receive a statement from your health care provider, make adjustments and always ask questions when in doubt. There is help available.

You are already battling health problems. Keep the payment process simple through education.