Understanding Your Explanation of Benefits (EOB)
Every time you receive care from a provider or file a claim for services received, your insurer will send you an “Explanation of Benefits.” This form is not a bill. It explains what medical treatments and/or services were provided and the amount the insurance company will pay towards any covered charge.
It is important to take note of the following information on your EOB:
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- Verify that the name of the patient and provider seen is accurate
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- Verify date for the service performed
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- Review the procedure code and brief description of the service performed
- Review the billed amount as well as the allowed amount for the service</l
- Review the amount the insurance paid as well as the amount the patient is responsible for paying within plan structure
- Review instructions related to appeal rights including important timelines for appeal submissions
The information presented within the EOB should make it easy to match bills from providers and ensure accuracy.
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