An EOU is a statement from your health insurance company that describes the costs it covers for the medical care or products you have received. The EOU is generated when your provider submits a claim to the services you receive. Keep in mind that CBOs show the costs associated with your care, but are not bills. These documents are quite standard with insurance companies. Here is a description of what each page of an EOU contains: The exact layout and form of the EOU varies by insurance company. But a simple EOU includes: A declaration of benefits (EOU) is the written statement of the insurance company of a claim that describes what it has paid and what the patient must pay. The document is sometimes accompanied by a benefit cheque, but it is more common for the insurer to send the payment directly to the medical provider. There may be cases where an insurance company rejects a claim but reconsiders it when you provide certain information (so-called «benefit coordination/COB» information). Some of this information may include: Patient Liability: You may be responsible for paying an amount of fees/services. This amount is based on your insurance benefits and what the institution and provider charge. The actual billing and the amount you owe will be sent by the healthcare facility that provided the service. An explanation of the benefit statement will be sent to you after a health insurance claim. It determines the details of the service, the provider`s fees, the amount covered by the insurance and the amount remaining due.
Whenever they provide services to you, doctors, dentists and other health professionals will file claims with your insurance company. That is how they receive the payment. In return, the insurance company will send you an EOU. This serves to inform you about the claims filed, how much is covered by the insurance and how much you owe. The account summary, which lists your account information with details such as the patient`s name, date(s), and claim number. Pay special attention if your insurance company needs additional information from you. If you can provide it to your insurance company as soon as possible, they can check it. A member with secondary insurance gives this information to the supplier for the next invoice that goes to that insurance company. In general, secondary insurance only pays the amount for which the EOU indicates that the member is responsible. Secondary OEBs indicate whether the patient still bears responsibility to the provider. Once the Member`s insurance companies have processed the claim, the Supplier will charge the Member the balance, if any.
[4] Your insurance company will usually ask you to update your Benefit Coordination Information (COB) annually. At the time you receive your patient bill, you will also receive a Declaration of Performance (EOU) from your insurer. An explanation of benefits is a document that explains how your insurance company has managed entitlement to the services you have received. Once you`ve created an online account, check the digital access options offered by your insurer. In most cases, you can sign up to receive email notifications when EABs are available. This way, you can view them instantly, so you don`t have to wait for them to arrive in your mailbox. An Explanation of Benefits (EOU) provides details about a health insurance claim that has been processed. It explains how much was paid to the health care provider; It also tells you which part of the payment, if any, is your responsibility. The billing office can help you understand why your explanation of benefits may be rejected.
A rejection can occur for several reasons. Here are some of the most common ones you`ll see on an EOU: Usually, there`s also at least a brief explanation of all the claims that have been denied, as well as a point for filing an appeal. [3] Medical bills can be confusing. An explanation of benefits (EOU) can help break down the different components. If you learn to read this important document, you will be able to understand why you owe the fee. Depending on your health insurance plan, page 3 may also indicate which portion of your pocket medical expenses is included in your annual deductible. While all performance statements look a little different, they all contain the same types of basic information: additional information may include instructions on the language medium as well as more specific details on filing a complaint in your country of residence. Just as healthcare providers can make billing errors, coding errors can occur when insurance companies process SOBs. If you don`t understand something about your EOU or if you think your insurance policy covers an expense that hasn`t been paid, call your insurance company for an explanation.
The explanation of the service bill is often received by mail. In most cases, it is very similar to a medical bill. What happens if you find a bug in your EOU and the insurance company can`t fix it immediately, or if there is a disagreement? You may need to have the benefit reviewed as part of a longer process or file a formal legal battle. Many insurance providers, such as Blue Cross Blue Shield, will provide samples of EOB on their website. You can consult them to familiarize yourself with what THE EB looks like and how the information is presented. An explanation of benefits (commonly referred to as form EOU) is a statement sent by a health insurance company to insured persons explaining what treatments and/or medical services have been paid for on their behalf. [1] The EOU is not an invoice, although it explains any fees that the patient still owes or may have already paid (e.g. B in the form of a co-payment at the time of medical care). If the patient owes additional money after the insurance company has paid their share, the medical provider will send a separate bill, which should match the patient`s share indicated in the EOU. Page 2 contains a glossary of terms and definitions included in your EOU, as well as instructions on how to appeal a claim if necessary.
EPO are a tool to show you the value of your health insurance. You will see the cost of the services you have received and the savings your plan has allowed you to achieve. EABs also help you assess how much money you have left in accounts linked to your plan. On some levels, THE EABs also show you how close you can be to your annual deductible. Once you reach your deductible, your plan starts helping you pay for services. Most of the time, there will also be a section that describes them all: Most insurance companies now offer you online access to your account. This may include digital access to EPO. If you don`t have online access to your account yet, check with your insurance company to find out how to get it. An EOU can help you not pay more for health care than you should. Check an EOU when it arrives by mail. Then, compare it to your bills to make sure you`re paying the right amount. If you find an error on a bill from a doctor or other provider, call your insurance company.
They will help you correct the gap. Deductible: A deductible is the amount you pay for health services before your insurance company starts paying anything. Co-payment: A co-payment is a fixed amount that you pay for a health service covered by your insurance. It is usually due before we offer the service. Co-payments are different for different services in the same plan. You can pay a different co-payment for your basic service than for a special service. Assessments for emergency care are also higher than for other assessments. While this document is not an invoice, it is an important tool that will show you how your bill will be split between medical providers, your insurance company and you.
They can help you get all the benefits or discounts you are entitled to under your insurance plan. What if you don`t understand why you owe money or just have trouble reading the EOU? You can also call your insurance company or health care provider to explain the details. Co-insurance: Depending on your insurance benefit, co-insurance is the amount you may have to pay for the claim, with the exception of co-payments or deductible. A health care provider will bill your insurance company after receiving your care. Then you will receive an EOU. Later, you can receive a separate invoice for the amount you may owe. This bill includes instructions on who to forward the payment to – either to a health care provider or to your health insurance company. University of Utah. «Explanation of benefits.» Retrieved July 2, 2021. Register your EOU when it arrives by mail! If you need to tell us about your bill, please have your EOB ready. The EOU may look like an invoice, but it doesn`t. It can also be difficult to find meaning.
You may need to call your insurance company to ask questions about the EOU. .