Explanation of benefits. plz explain this in detail.

by Faraz Ali Khhan
(Delhi, India)

I just need to clear my thoughts regarding explanation of benefits (EOB). Sorry to say but I have not yet cleared this so plz will you explain this.



Thanks!
Faraz

Thanks for the question Faraz - here's my attempt to answer and explain the Explanation of Benefits:

If a patient has medical insurance, the doctor's office submits a claim to the patients insurance company for the visit to the doctor. This contains the ICD-9 diagnosis and CPT treatment codes for the procedures performed by the doctor.

The Explanation of Benefits (or EOB) is a form or report that provides details and results of the insurance companies processing of the claim. It is provided to the doctor with insurance company payment and contains information about the claim such as:

  • Patient name and policy number.

  • Date of visit - called the Service Date

  • Amount charged by the doctor for servic.es provided.

  • Amount not covered by insurance - sometimes referred to as "Write-Off".

  • Amount allowed by the patients policy.

  • Copay and Deductible - this is the amount the patient has to pay based on their policy.

  • Any remark codes or special explanations regarding payment.


The EOB may also includes information on the patients year-to-date status with regard to deductibles and out-of-pocket costs.

As a medical biller, we use the information from the EOB to enter into the practice management software that keeps up with payment information. If there is any remaining uncovered amount due, a statement is generated and mailed to the patient.

Hope this helps clear up any questions you have on EOB's.

Thanks for the question,

Gina

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