Healthcare Buzz: Reading an Insurance Explanation of Benefits/EOB – Part 2

1) EOB insurances can take around 30 days from the date of service. In the meantime, you may receive an itemized bank statement or a monthly statement from your healthcare provider. If it is received before the insurance EOB, keep it as a good reconciliation tool. (It can be said: This is not an invoice, as it is an information document). to the permitted amount. This is an invoice. (Remember, refer to part one on how to read the EOB.)

2) Now is the time to compare health declaration vs. EOB insurance side by side.

3) Each HCP statement is unique to that provider. Each EOB is unique to that insurance plan. Familiarize yourself with your insurance EOB – follow the steps in the first part article.

4) Using the two documents, start matching: date of service, billed charges, amount paid by insurance, absorbed amount – difference between billed charges and contracted/permitted amount and the final amount due.

5) There are no shortcuts to this step by step process. Sometimes there are questions about charges or services that have been billed. Definitely call the healthcare provider for clarity as the insurance plan can only answer how the claim was paid for, not whether the services were performed.

Due to the time lag between services and paying for your insurance, there can easily be gaps in your memory of what was done.

Again, ask and make sure there is clarity as the patient portion is calculated based on individual insurance coverage.

Let\’s look at the following example from the first part. Using the EOB example, make sure that all totals match the comparison with the healthcare professionals statement. All totals should be represented as follows. The amount owed to the vendor in the example below would be $13 because the deductible has not been met.

EX) Doctor (sometimes patients have services and can\’t remember what was actually done.

This was a preoperative ECG interpretation performed by a physician/unknown to the patient. The doctor\’s name is listed for each line.) Billed amount: $18 Uncovered amount: $5 Your discounted/in-network/allowed rate $13.

Applied to your $13 deductible.

Amount paid by the insurance $0 as the $3500 deductible was not met, so the insurance plan paid zero.

The total amount owed to the healthcare provider is $13/network discounted rate/contracted rate.

The difference between the charges ($18) and the discounted/allowable amount ($13) is written off by the provider ($5) as part of contacting your insurance plan.

The process can be difficult, but take it one step at a time. Be patient. Build a good understanding of how your insurance plan pays, and when in doubt, always ask. Once you receive the statement from the healthcare professional, reconcile and, if in doubt, always ask. There is help available.

You are already struggling with your health issues. We try to keep the payment process simple through education.