Your insurance company should send you a form explaining what they paid on charges submitted by your physician. This form is referred to as the Explanation of Benefits, or “EOB” for short.
Your Explanation of Benefits will tell you if your charges were applied to your deductible or denied for some reason. They will also tell you how much was paid, how much was adjusted off due to the contractual agreement between your insurer and your provider, and how much is left for you to pay.
Most EOB’s show a breakdown of the charges under several headings which usually read from left to right. The most common headings are:
Sometimes the insurance company will deny (refuse to pay) a charge for some reason. In this case, the EOB will contain alpha or numeric codes next to each procedure which indicate the reason for the denial. The explanation of these codes will often be found at the bottom of the page or on the reverse of the EOB. Some denial codes require the patient to contact the insurance carrier in order to resolve questions or other issues that are preventing payment from being made.
It is advisable to compare insurance EOB’s to the bill received from the medical provider. Check to see if the payment was posted correctly and the amount owed on the bill matches the amount indicated on the EOB. Springfield Clinic makes this comparison easier by including detailed charge and payment information on all Clinic statements. Any questions can be directed to our Patient Service Representatives at 217.528.7541 or toll-free at 800.844.7541, Monday through Friday, 8:00 a.m. – 5:00 p.m.
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