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Explanation of Benefits (EOB)

 

As a patient advocate, you frequently receive questions regarding

bills. A patient called today and asked for you to explain a form that she received from her insurance company. She said the form was call an Explanation of Benefits. She said that it provided the following information:

Provider:                            Dr. T Simmons

Date:                                    11/11/13

Type of Services:             Office Visit

Amount Submitted:       $82.00

Amount Allowed:            $74.00

Coinsurance:                     $14.80

Deductible:                        $300.00

Copay:                                 $20.00

 

1.      How would you explain what an EOB form is?

2.      How would you explain the difference between the amount submitted and the amount allowed?

After you explain the amount allowed to her, she gets irate and exclaims, "How dare Dr. Simmons overcharge me by $8.00!" She then said that she was going to call his office and give him a piece of her mind. Who will you respond to her comment?

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1.How would you explain what an EOB form is? Solution: An explanation of benefit form is a complete statement given... View the full answer

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