An EOB is a document that explains the benefits of an insurance policy, detailing treatments, costs covered, and remaining amounts to be paid by the patient. It helps maintain a history of medical treatment and aids in accounting for medical expenses. It also includes information on why a payment was denied or approved. It can be received electronically or as a hard copy.
An EOB is a document issued by an insurance provider to a customer as an explanation of benefits in connection with the terms of insurance coverage. Most often, the explanation of insurance benefits has to do with recent treatments administered by a doctor or health center. The EOB details the treatments that were performed, the portion of the cost that is covered by the terms of the policy, and the remaining amount that the patient must pay directly to the health care provider.
EOB insurance serves several useful functions. First, the document helps create a documented trail of all actions taken regarding a specific medical claim filed by the treating physician. This helps the patient and the insurance provider 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 when it comes to medical expenses. The medical explanation of benefits clearly defines the total billed cost for various medical services, the amount covered by the insurance provider, and the remaining amount to be paid by the patient. This leaves no doubt in the patient’s mind about the amount still owed in medical debt.
Most insurance providers also include information related to why you are paying or denying a line that is on the EOB. When the payment is not extended on a particular item, there is usually a field where an explanation of the action is detailed. For example, the explanation may be that the patient has not yet met the deductible associated with the coverage, so no payment has been issued to the healthcare provider. If the patient has met the deductible and the terms of the policy allow the provider to pay a set percentage of the outstanding balance, that is also included in the details. Information of this type is very important, especially if the patient wants to appeal the decision of the insurance provider.
Almost any medical EOB can be considered a comprehensive statement of health benefits, effectively providing the patient with a simple document that can be easily referenced to the terms and conditions found in the health insurance policy. Today, many providers offer customers the opportunity to receive electronic copies of the document via email, as well as the more traditional approach of receiving a hard copy via the local postal service.
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