Decoding your Medical Bill

Do you know what an EOB is? Can you figure out what it says?⁣

It is critical to understand the Explanation of Benefits (EOB) that your insurance company provides. The EOB is a report to you and the provider of services on exactly how the insurance claim was processed. It is essential to review this to determine what the insurance company has paid and what your responsibility is. The EOB must be reviewed carefully and can frequently have incorrect coding, which can significantly affect the amount you might owe.⁣

Other terms on the EOB that are important to know:⁣

The deductible is the amount of money you have to pay before the insurance benefits begin.⁣

A copayment is the specific dollar amount that the insured is required to pay at the time of a doctor’s visit. Co-payments are not subject to deductible so it does not count towards the out of pocket maximum.⁣

Coinsurance (allowed amount), after the deductible is met, is an expense to be paid be the insured that is a percentage of the provider’s charge.⁣

Out-of-pocket maximum is the amount the insurer has to meet in order for the insurance company to pay 100 percent of the policy’s benefits.⁣

If you or a loved one are in need of help to navigate the healthcare system, give us a call. We are here to help.⁣