Your insurance EOB, or Explanation of Benefits, summarizes the cost of each of your medical visits including what your insurance paid and what amount you owe to your provider(s). An EOB is not a bill, but will detail what amount of the bill is your responsibility to pay.
Here are some of the most common terms on an EOB, defined:
Date of Service
Date of Service is the date that services were provided to you, i.e. the day of your appointment.
Provider Charges is the amount your medical service provider billed to your insurance company for your appointment.
The Allowed Charges amount is the maximum amount your insurance company will pay for each appointment. This amount will differ by insurance company, and is based on their contracted rate with your provider(s).
When your insurance company receives a claim from a medical provider (such as BPHT), they will apply a discount based on their contracted rate. So, Provider Charges – (minus) Allowed Charges = Patient Responsibility.
Patient Responsibility is the amount you owe. This may be classified as a Copay, Deductible, or Coinsurance.
A copay is a fixed amount you will pay for a medical appointment or prescription at the time of service. For example, if your copay is $40, you can expect to pay $40 out of pocket each time you have a therapy or doctor appointment, or fill a prescription.
A Deductible is the amount of money you must pay out of pocket before your insurance company will cover its portion of your medical visits. If your deductible is $3000, expect to pay the first $3000 for healthcare services that are (1) covered by your insurance plan, and (2) subject to the deductible. Your insurance will pay for some or all of your services after your deductible amount is met.
Please note, some preventive services and other expenses may not be subject to your deductible, and may be covered, or subject to a Copay or Coinsurance. If you have questions about your specific insurance coverage, deductible, benefits, and what you will owe, please contact your insurance company directly at the phone number listed on the back of your insurance card.
Coinsurance is the portion of your medical costs you’ll pay after your insurance processes your appointment claims. For example, if your Coinsurance is 20% and your provider’s Allowed Charges are $100, you will owe $20 to your provider. Your insurance will pay the remaining $80 to your provider.
Depending on your insurer and your plan, Coinsurance payments may apply toward your deductible. For other plans, Coinsurance will apply after your deductible is met. Please contact your insurance company for details on your specific plan.
Understanding Your Benefits
As a courtesy, BPHT may contact your insurance company to confirm benefits. However, it is your responsibility to understand your insurance coverage, and to pay for any balance due in a timely manner.
Insurance can be confusing at times. So if you have questions about your specific healthcare coverage, deductible, benefits, and what your out of pocket expenses will be, please contact your insurance company directly at the phone number listed on the back of your insurance card.
Thank you, it is our pleasure serving you and your family.