An explanation of benefits (EOB) statement provides details about a health insurance claim that has been processed. It explains what portion was paid to the health care provider; it also tells you what portion of the payment, if any, is your responsibility. Medical bills can be confusing.
What does the explanation of benefits really mean?
The insurance company sends you EOBs to help make clear:
- The cost of the care you received
- Any money you saved by visiting in-network providers
- Any out-of-pocket medical expenses you’ll be responsible for
What does explanation of benefits stand for?
Explanation of benefits. A health care acronym that stands for the description of medical treatments and services that a health care provider has paid for on the behalf of the individual; sent by the health insurance company to patients.
What does explanation of Benefits (EOB) actually explain?
The Nitty Gritty
- Prior Authorizations. ...
- Personal Note. ...
- Medical Necessity. ...
- Explanation of Benefits (EOB) Knowing how to read an EOB is INCREDIBLY important when trying to understand health insurance. ...
- Primary and Secondary Payers. ...
How to read your explanation of benefits?
How to Read Your Explanation of Benefits. An EOB from Delta Dental will typically include the following information: Top of Your EOB: You will see a section that contains subscriber and member identification information, dentist name and the claim number. You might need this information to check on the status of a claim status.
What means Explanation of Benefits Why are important?
The most important thing for you to remember is an EOB is NOT a bill. It's letting you know which healthcare provider has filed a claim on your behalf, what it was for, whether it was approved, and for how much. You should always review your EOB to make sure it's correct.
What do you do with Explanation of Benefits?
What should you do with an EOB? You should always save your Explanation of Benefits forms until you get the final bill from your doctor or health care provider. Compare the amount you owe on the EOB to the amount on the bill. If they match, that's the amount you'll need to pay.
What is explanation of insurance benefits?
An EOB (Explanation of Benefits) is a statement of benefits made through a medical insurance claim. Although an EOB statement may look like a medical bill it is not a bill. It's a series of details on processed medical claims and how much the insurer paid to the healthcare provider.
What is the purpose of the assignment of benefits?
Assignment of Benefits (AOB) is an agreement that transfers the insurance claims rights or benefits of the policy to a third-party. An AOB gives the third-party authority to file a claim, make repair decisions, and collect insurance payments without the involvement of the homeowner.
Should I keep explanation of benefits?
When you or someone you are caring for is seriously ill, it is recommended that you keep EOBs for five years after the illness or condition is alleviated. If you or the patient is claiming or has claimed a medical deduction, keep the explanation of benefits for seven years.
What is COB in medical billing?
Insurance Term - Coordination of Benefits (COB) This is a provision in the contract that applies when a person is covered under more than one health insurance plan. It requires that payment of benefits be coordinated by all health insurance plans to eliminate over-insurance or duplication of benefits.
What is an Explanation of Benefits quizlet?
Explanation of Benefits (EOB) insurance report that is sent with claim payments explaining the reimbursement of the insurance carrier. Adjudicated. How a decision was made regarding the payment of an insurance claim.
What's another term for Explanation of Benefits?
Explanation of benefits, also called an EOB.
What is allowed amount on EOB?
The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”
What is assignment of benefits in healthcare?
Assignment of Benefits: An arrangement by which a patient requests that their health benefit payments be made directly to a designated person or facility, such as a physician or hospital.
What does it mean to accept assignment of benefits?
“Assignment of Benefits” is a legally binding agreement between you and your Insurance Company, asking them to send your reimbursement checks directly to your doctor. When our office accepts an assignment of benefits, this means that we have to wait for up to one month for your insurance reimbursement to arrive.
What is the definition for assignment of benefits quizlet?
Assignment of benefits means the patient and/or insured authorizes the payer to reimburse the provider directly.
What is EOB in insurance?
An explanation of benefits (EOB) is the insurance company’s written explanation regarding a claim, showing what they paid and what the patient must pay. The document is sometimes accompanied by a benefits check, but it’s more typical for the insurer to send payment directly to the medical provider. The EOB is not a bill, although it will explain ...
What happens if a patient owes additional money to the insurance company?
If the patient owes additional money after the insurance company has paid its portion, the medical provider will send a separate bill, which should match the patient’s portion listed on the EOB. How to read a health insurance EOB.
What is EOB in healthcare?
Updated on July 19, 2020. An explanation of benefits (EOB) is a form or document provided to you by your insurance company after you had a healthcare service for which a claim was submitted to your insurance plan. Your EOB gives you information about how an insurance claim from a health provider (such as a doctor or hospital) ...
What is EOB in medical billing?
Your EOB is a window into your medical billing history. Review it carefully to make sure you actually received the service being billed, that the amount your doctor received and your share are correct, and that your diagnosis and procedure are correctly listed and coded.
What does EOB mean for medical?
Your EOB will generally also indicate how much of your annual deductible and out-of-pocket maximum have been met. If you're receiving ongoing medical treatment, this can help you plan ahead and determine when you're likely to hit your out-of-pocket maximum. At that point, your health plan will pay for any covered in-network services you need for the remainder of the plan year.
What is EOB information?
Your EOB has a lot of useful information that may help you track your healthcare expenditures and serve as a reminder of the medical services you received during the past several years.
What is an EOB?
Your EOB gives you information about how an insurance claim from a health provider (such as a doctor or hospital) was paid on your behalf—if applicable—and how much you're responsible for paying yourself.
What does "not covered" mean on an EOB?
Not Covered Amount: The amount of money that your insurance company did not pay your provider. Next to this amount you may see a code that gives the reason the healthcare provider was not paid a certain amount. A description of these codes is usually found at the bottom of the EOB, on the back of your EOB, or in a note attached to your EOB. Insurers generally negotiate payment rates with healthcare provider, so the amount that ends up being paid (including the portions paid by the insurer and the patient) is typically less than the amount the provider bills. The difference is indicated in some way on the EOB, with either an amount not covered, or a total covered amount that's lower than the billed charge.
What is a provider?
Provider: The name of the provider who performed the services for you or your dependent. This may be the name of a doctor, a laboratory, a hospital, or other healthcare providers. Type of Service: A code and a brief description of the health-related service you received from the provider.
What is an EOB bill?
An EOB is not a bill, but rather a statement of rendered services outlining the provider charges, plan discounts and/or coverages, and the remaining participant responsible balance.
What is an EOB?
An Explanation of Benefits, often referred to as an EOB, is a document that describes what costs a health insurance plan will cover for incurred healthcare and related expenses. EOBs are created when an insurance provider processes a claim for services received.
