What is an “EOB”?
An EOB is a document issued by an insurance provider to a client as an explanation of benefits as they relate to the terms of the insurance coverage. Most often, the insurance explanation of benefits has to do with recent treatments administered by a physician or healthcare facility. The EOB details the treatments that took place, the portion of the cost that is covered under the terms of the policy, and the amount remaining for the patient to pay directly to the healthcare provider. The insurance EOB serves several useful functions. First, the document helps to create a documented trail of all actions taken in regard to a specific medical claim submitted by the attending physician. This helps the patient and the insurance provider to establish and maintain a history of all types of medical treatment the individual has received since the policy was initiated. For the patient, an EOB makes it easier to keep up with the accounting process as it relates to medical expenses. The medical ex
EOB stands for Explanation of Benefits. This is a report included with or without a check from the insurance company which explains the benefits that were paid and/or charges the insurance company will not pay. Sometimes the rejected charges must be paid by you (“copay”), and sometimes the charge need not be paid at all because it is more than the preset fee arranged with the doctor.
When health insurance organizations commonly called Payers adjudicate a medical claim, they send the Provider payment with an EOB, which lists the details of each claim patients, dates of service and a list of services provided. The EOB details the amount billed, and paid for each claim, with an explanation of the benefits covered. Depending on the business rules of the Payer, benefits can be denied simply because the wrong box was checked on a claim, or the wrong CPT code was used. If Providers dont carefully evaluate each EOB, they potentially lose 10% to 20% of funds for which they are entitled. Payers often bundle together claims for all members of a plan who have had services by the Provider within a given time period. As a result, EOBs can be 100 pages or more, with hundreds of individual claims and thousands of service lines to audit.
