

Understanding Explanation of Benefits

Once you are home you will receive what is called an Explanation of Benefits (EOB) which will explain what your insurance covered, how much and what your responsibility for payment will be.  The EOB will show the following:

Explanation of Benefits

Service Detail

1.  Your name and address in the left upper section

2.  Health plan, identification number, contract number and claim date are in the right upper corner.

3.  The first row of information begins with the enrollees claim number followed by the services performed for which payment has been requested.  

4.  Next you will see a date of service followed by the amount charged.  It is important you verify that the service billed is the one you received.  You may be surprised at how some unethical services take advantage and bill for more than what they should.  Medicare depends on their enrollees to notify them if they feel there has been a serious mistake.  

5.  After this you will see the amount not covered and then the amount allowed.  

6.  This is followed by any copay or deductible and then the percentage paid depending on your plan.  

7.  This will finally result in the amount the plan will pay.  

Your Deductibles

8.  Your name

9.  Your annual deductible (Amount you have paid out of pocket)

10.  The amount to date

11.  The maximum annual deductible (That you are expected to pay before insurance pays)

the amount of deductible to date

With this information, you will be able to know how much you have spent, how much you still need to spend before insurance kicks in and how much will be spent on your behalf.

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