An EOB is a name given to a document that is issued by an insurance provider to a client as an explanation of benefits as they relate to the terms of the insurance coverage. Usually, the insurance explanation of benefits are related with recent treatments that are administered by a physician or health-care facility. In the EOB there are details of the treatments that took place, the portion of the cost that is covered under the terms of the policy, and the amount that is left for the patient to pay directly to the health-care provider.
Functions served by EOB
Several useful functions are served by the insurance EOB. First of all, a documented trail of all actions taken in regard to a specific medical claim submitted by the attending physician is created by the document. By this the patient and the insurance provider are helped to establish and maintain a history of all types of medical treatment that has been received by the individual since the policy was initiated.
Accounting process becomes easier
For the patient, by an EOB it becomes easier to keep up with the accounting process as it is related to medical expenses. The total billed cost for various medical services, the amount covered by the insurance provider, and the amount remaining for the patient to pay are clearly defined by medical explanation of benefits. With this no question is left there in the minds of the patient as to the amount that is still owed on the medical debt.
Explanation is written for every Action
Information related to the reason for paying or denying a line item found on the EOB is also included by most insurance providers. When on a particular item payment is not extended then there is normally a field where an explanation for the action is detailed. For instance, no payment was issued to the healthcare provider as the explanation may be that the patient has not yet met the deductible associated with the coverage.
If the deductible and terms of the policy has been met by the patient the it allows the provider to pay a fixed percentage of the outstanding balance, that is also included in the detail. This type of information is very important, particularly if the patient wishes to appeal the decision of the insurance provider.
EOB as a comprehensive health benefits statement
Just about any medical EOB can be considered as a comprehensive health benefits statement, that effectively provide a simple document to the patient that can easily be cross-referenced with the terms and conditions found in the health insurance policy. Today, many customers are offered the opportunity to receive electronic copies of the document via email by the providers, as well as the more traditional approach of receiving a hard copy through the local postal service.
