[{"@context":"https:\/\/schema.org\/","@type":"BlogPosting","@id":"https:\/\/reflexknees.com\/blogs\/what-is-an-explanation-of-benefits-eob-understanding-health-insurance-part-4\/#BlogPosting","mainEntityOfPage":"https:\/\/reflexknees.com\/blogs\/what-is-an-explanation-of-benefits-eob-understanding-health-insurance-part-4\/","headline":"What is an Explanation of Benefits (EOB)? \u2013 Understanding Health Insurance, Part 4","name":"What is an Explanation of Benefits (EOB)? \u2013 Understanding Health Insurance, Part 4","description":"The last time you visited the doctor\u2019s office or were treated for a medical issue, you may have received a document in the mail from your insurance company clearly marked, \u201cNOT A BILL.\u201d Although this paperwork can indeed appear as an invoice at first glance, it is actually what your insurance company refers to as […]","datePublished":"2015-10-07","dateModified":"2024-01-09","author":{"@type":"Person","@id":"https:\/\/reflexknees.com\/author\/developer\/#Person","name":"Nick Petersen","url":"https:\/\/reflexknees.com\/author\/developer\/","identifier":2,"image":{"@type":"ImageObject","@id":"https:\/\/secure.gravatar.com\/avatar\/8ea7fc410413ee0b715aee4c6b2d912c09623af5f85eaca6f6d7e0a2c223e1df?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/8ea7fc410413ee0b715aee4c6b2d912c09623af5f85eaca6f6d7e0a2c223e1df?s=96&d=mm&r=g","height":96,"width":96}},"publisher":{"@type":"Organization","name":"Reflex Knee Specialists","logo":{"@type":"ImageObject","@id":"http:\/\/b1ec2b6df7.nxcli.io\/wp-content\/uploads\/2023\/03\/logo.png","url":"http:\/\/b1ec2b6df7.nxcli.io\/wp-content\/uploads\/2023\/03\/logo.png","width":169,"height":104}},"image":{"@type":"ImageObject","@id":"https:\/\/reflexknees.com\/wp-content\/uploads\/2023\/06\/2518065.webp","url":"https:\/\/reflexknees.com\/wp-content\/uploads\/2023\/06\/2518065.webp","height":1536,"width":1536},"url":"https:\/\/reflexknees.com\/blogs\/what-is-an-explanation-of-benefits-eob-understanding-health-insurance-part-4\/","about":["Blogs"],"wordCount":772,"articleBody":"The last time you visited the doctor\u2019s office or were treated for a medical issue, you may have received a document in the mail from your insurance company clearly marked, \u201cNOT A BILL.\u201d Although this paperwork can indeed appear as an invoice at first glance, it is actually what your insurance company refers to as an\u00a0Explanation of Benefits, or EOB. Insurance companies send out EOB\u2019s to notify you of what services they\u2019ve billed on your behalf \u2013 this effort helps to minimize fraud and inform patients of what their insurance covers. In this blog post, we\u2019ll explore what an EOB describes, the components of this type of document, and how it factors into billing. What does an EOB typically describe? An EOB can be helpful to understand different aspects of your insurance, including:The roles of the payee (the medical office billing for services), the payer (health insurance company) and the patient (you)Elements of the service performed: the date of the service, the description and\/or\u00a0Current Procedure Terminology\u00a0(CPT) code for the service, the name of the person or place that provided the service, and the name of the patientThe doctor\u2019s fee, and what the insurer allows\u2014the amount initially claimed by the doctor or hospital, minus any reductions applied by the insurerThe amount the patient is responsible forReasons for adjustment and adjustment codes (any amount of the bill taken off by the insurance company before payment)Keeping informed of these elements can clear up questions about your payments and charges \u2013 and if you have\u00a0questions to ask your insurance company, your EOB can equip you with information to expedite the process. How does an EOB factor into the billing process? Aside from your monthly insurance premium payments, you should never receive a bill directly from your insurance company. All the bills you receive for services and treatments come directly from the medical office. That said, your EOB is helpful to understand your charges and how your insurance covers your expenses. When a claim gets submitted to your insurance company, your insurance will make adjustments and pay their applicable portion based on your policy. With these amounts, an EOB is sent to you (the patient), and an Explanation of Payment (EOP) is sent to the medical office. These items inform both the patient and medical office about the portion of the claim paid by insurance \u2013 any remaining amount becomes the member\u2019s responsibility. See an example of an EOB below:  EOB You\u2019ll note that at the top of the page it states what the document is (an EOB) and what it is not (a bill). Highlighted in yellow are the key elements:Charges:\u00a0The amount that was billed to the insurance company from the medical providerProvider Responsible Amount:\u00a0The amount your insurance company is obligated to pay for based on your policyMember Responsibility Section:\u00a0Expenses that may fall to the insured person, and what part of your plan these costs comes fromAmount You Owe:\u00a0The total amount for this service you as the patient are responsible for. On this example EOB, the member is only responsible for $20. This quantity will get billed to you directly from the office you visitedWhen Will I Receive an Actual Bill? The timeline for when exactly you get billed can depend on several factors. Claims need to be submitted by medical providers to insurance companies within a certain window of time \u2013 this window varies based on the insurance company. Typically, claims are submitted anywhere from 30 days to a full year after you receive service. However, our insurance and billing department at Reflex works hard to get claims submitted within a month of service. Once the insurance company has received the claim, they have an average of 30-90 days to process this claim and send an EOP to the medical office. Once the medical provider receives the EOP, they will bill you directly for your portion during their next billing cycle. In the end, you likely won\u2019t receive a bill for medical services until several months after you had the actual treatment or visit. Should you ever have any questions about a bill you receive from Reflex, please give our office a call and someone from our Insurance and Billing Department will happily review it with you. If you are struggling with chronic or intermittent knee pain that is affecting your daily life, call to\u00a0schedule an appointment\u00a0with one of our specially trained physicians today at (503) 719-6783."},{"@context":"https:\/\/schema.org\/","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"Blogs","item":"https:\/\/reflexknees.com\/blogs\/#breadcrumbitem"},{"@type":"ListItem","position":2,"name":"What is an Explanation of Benefits (EOB)? \u2013 Understanding Health Insurance, Part 4","item":"https:\/\/reflexknees.com\/blogs\/what-is-an-explanation-of-benefits-eob-understanding-health-insurance-part-4\/#breadcrumbitem"}]}]