Health Insurance Explanation of Benefits

Understanding an EOB and Your Bill | Medical Business Systems

1. An EOB is not a bill,

2. Write Off = Billed Amount – Allowed Amount

In order to understand it, you need to realize that the provider almost
always bills more than is expected to be paid
So, even though $431.00
was billed, the provider is technically only able to bill $193.15.  The
difference is written off and neither the insurance company nor the
patient is expected to be responsible for this amount.  The provider
must adjust it off.  The write off/adjustment process must take place
every time the provider sends a bill out.  Patient responsibility such
as deductibles and co-insurance are calculated from the allowed amount,
not the original charge amount
.  Often, invoices are sent directly to
the patient before this process takes place.  When the patient receives
the original bill before the write off process, the cost can seem
overwhelming.  That is why it is important that the patient understands
the EOB and waits for the write-off process to occur before paying the
bill.

Wait for an EOB from your insurance company before paying for services
that appear on your physician’s invoice. If you have more than one
insurance company, wait for all EOB’s showing each determination.
Remember, the “billed amount” minus the “adjustment” or write-off equals
“allowed amount.” Patient responsibilities are based on this “allowed
amount” and subtracted from it before the physician gets a payment. The
physician will bill the amount marked “Patient Responsibility” on the
EOB.  All this information should be conveyed in the patient bill. 
Let’s look how this would appear based on the example EOB above.

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One Response to Health Insurance Explanation of Benefits

  1. hgh says:

    I opine this is a realistic eager article aggregation.Thanks Again. Really Great.

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