Financial literacy is key to financial success, and one of the pillars of this success is recognizing the value and benefits of health insurance—no matter the type. Getting insurance and claiming its benefits come with a lot of paperworks, and the policyholders must understand what all these documents mean to make the most out of their insurance plans, especially when they receive a copy of their Explanation of Benefits (EOB).
Aside from personal agents, a policyholder can expect to get the most reliable insurance-related assistance from benefits consultants like Crabtree Benefits at affordable rates. Benefits consultants can help analyze EOBs and maximize the policyholder’s owed benefits.
Insurance policies have different benefits related to the plan you’ve paid for, and these are all enumerated, together with their terms and conditions, on your Explanation Of Benefits (EOB). To put it simply, an EOB is a document provided by the policyholder’s insurance carrier regarding a claim.
EOBs closely resemble a medical bill as they mostly come from health insurance plans. When the policyholder attends a doctor’s appointment or gets hospitalized, the doctor’s office sends a claim to the insurance provider. EOBs are then delivered by the claims department of the health plan provider processing the policyholder’s medical expenses.
As EOBs might look like medical bills, policyholders shouldn't get confused lest to overlook important sections. EOBs are not the actual breakdown of your medical expenses. However, you can use them as a reference to match its content on the medical bill.
The name of the doctor, including its spelling, should be correct. Claims can be miscoded if the doctor’s name isn’t accurate—or there’s another doctor with the same name from a different hospital or department. The insurance provider may charge the policyholder for a different or a more expensive service if the information about the doctor isn’t accurate.
In line with the doctor’s name, the exact type of service should also be accurate. The policyholder must send at least one medical billing code to the insurance provider to verify the type of service billed and redeemed.
The date and range of service on the EOB may affect the total amount billed, especially if the service required hospital confinement. Policyholders must double-check the date of service. In addition, one must also consider the statement date or the date the insurance provider printed the EOB.
The most important section that shouldn’t be overlooked is the total amount billed from both the hospital and the insurance provider. The amount from the medical bill is the amount you owed to the hospital, but the amount from the EOB may include the plan discounts from the health plan. The discounts are determined when the claim is processed.
The policyholder should understand the EOB’s stated responsibility based on the type of plan he or she has. Here are the itemized responsibilities:
Copay – the amount that needs to be paid by the policyholder during the time of service.
Deductible – the amount the policyholder needs to pay before the insurance claim takes into effect. The deductible section shows how much of the bill is owed before the policyholder hits the deductible.
Coinsurance – If the deductible is met, the policyholder must pay the coinsurance or the certain percentage of the medical bill. The coinsurance ranges from 20% to 30%.
Limitation of Benefits / Services Covered – benefits or hospital services not covered by the health plan.
Every time the policyholder consults or seeks services from doctors, dentists, and other medical professionals, the doctor’s office must submit claims to the patient’s insurance provider. If the doctor’s office is incapable of filing a claim, the policyholder can submit the claim. In return, the insurance provider will have to send an EOB right away to inform the policyholder of the claims submitted, the amount covered by the health plan, and the amount that still needs to be settled.
EOBs are available via mail or email. They can be accessed online or have them delivered to the doorstep. Regardless of the method, policyholders should not pay their medical bills until they receive their EOBs to avoid paying unnecessary, hidden, or excess charges and to make sure that the insurance provider and its billing system comply with the Affordable Care Act (ACA), the comprehensive health care reform law in the United States.
EOBs are extremely important to policyholders with personal or company health insurance plans. EOBs can be used as a current and future reference when the policyholder redeems his or her benefits as the plan progresses.
Crabtree Benefits and other benefits consultants can help policyholders properly analyze their EOBs to make the most out of their benefits and discounts, avoid payment errors, draft a financial budgeting system, settle financial disputes, and organize tax documentation. The main goal here is to pay less and get the most equitable settlement for all medical expenses.
EOBs are sent by the insurance provider to inform the policyholder of his claim and medical expenses.
The doctor’s office or the policyholder can file an insurance claim to receive the health plan’s benefits. The policyholder must receive an EOB after the claim is processed.
EOBs should be used as a reference to understand and maximize the policyholder’s health insurance plan.
