Explanation Of Benefits is a document that provides an explanation of how an insurance service processes a claim made by the insured according to the service received. The EOB will usually be attached to a check or electronic payment, the EOB contains what fees are approved and refused by the insurer and how much the costs must be borne by yourself.
Services in insurance claims written in an EOB usually include things such as:
Services provided by insurance companies
Total medical costs (hospitals and doctors)
Costs covered and not covered by the insurance
What payments are approved by the insurance company to be paid according to the claim
Amount that is the responsibility of the insured (amount to be paid by yourself)
EOB is not a bill but this document is quite important for policyholders to read and understand because it contains details of medical costs or hospital treatment costs, costs incurred by the insurance company and costs incurred themselves.
Basic Information in Explanation Of Benefits
Account Summary – contains detailed information regarding the patient (insured) such as name, date of claim, claim number and others
Claim details – lists the services provided by the insurance company, when to provide these services and also the details of the services provided
Amount – contains the amount charged by the insurance company, the amount agreed to be paid by the insurance company and the discount between medical costs and costs incurred by insurance
Responsibilities of the insured – contains the amount or costs that must be borne by the patient (the insured) when there is a difference in the insurance benefits provided by health facilities, for example if you want to upgrade to a VIP room from the room below and so on
It describes what part of the service your insurance plan pays for and what part you are responsible for paying. Your insurance company sends it to you when your health care provider makes a claim on your behalf.
As we read the EOB, make sure you understand every line. Use it to track your expenses and make sure there are no billing errors.
When we visit a doctor, or other health care provider, we will usually be asked if you would like the service to be charged to your insurance. If you do, the medical office must fill out a health insurance claim and submit it to the health insurance company.
This is basically a request for payment to your insurance company to cover the cost of visits, maintenance, or equipment.
When insurance companies get a claim, they will evaluate the claim, make
Benefit Description (sometimes referred to as EOB) and send it to you by post.
They may also provide digital copies through their website.
You must accept EOB whether you have private insurance, insurance through your employer, or Medicare.
If you have made a letter in EOB.
The EOB contains the following information:
Your name, or the name of your dependents (whoever receives the service)
Your health insurance ID or policy number (or your dependents), and claim number
Name of health care provider who provides treatment for a doctor, dentist, specialist, laboratory, hospital, or clinic
The type of service or equipment you received and the date you received it; for services lasting more than one day, a date range will be provided.
Service fee (which your provider charges the insurance company)
How much is the bill paid by your insurance company
The remaining amount to be paid, which is usually your responsibility
The EOB may contain information about whether the amount you need to pay will be applied to your deductible. Sometimes the EOB also lists how much of your deductible remains for the year.
In simple terms, the explanation of benefits or EOB is a receipt or details of what types of funds are paid or covered by the insurance company. Ok, when we apply for insurance to the insurance company, the insurance company will explain in detail about the rights that the policyholder will get and what obligations must be paid to the insurance company. At that time, the two parties must match what is needed and what the insurance can cover.
When it is running and the policyholder already has the right automatically to file a claim, this explanation of benefits will appear. For example, policyholder A buys insurance that covers kidney surgery funds. Now, when the claim is made or the customer has performed kidney surgery, a record of the types of costs that are covered in the kidney surgery process will be issued. For example, the cost of hospitalization after surgery, the class of facilities to be provided and so on.
Usually the contents of this explanation of benefits are in the form of detailed patient data, services to be received, liability costs, benefits of discounts or discounts, things that are not covered by the insurance, reimbursement receipts for claims, etc.
This is a report document issued by the insurance company to the insured party or policy holder which contains an explanation of the detailed details of the costs incurred by the health service/hospital in terms of treatment and hospitalization costs in accordance with the health insurance benefits provided by the insurance party to the party. the insured is based on a policy agreement signed by both parties where the customer / patient receives direct benefits from the health insurance product provided.
This report document details the costs incurred by the hospital which will later be submitted to the insurance for payment claims and the claim report paid by the insurance is forwarded to the beneficiary (insurance customer) as a form of accountability and an explanation of a detail of how the insurance company processes a complete health insurance claim with details of the costs covered by the insurance.
Explanation of benefits (EOB) or direct benefit claims will help the insured to track expenses and avoid overpaying for additional services, and this is not a bill but a form of reciprocal benefit received by the customer for the insurance premium paid during the period. and has met the requirements and procedures for submitting a claim according to the type of health insurance product selected and paid so far.
