You had a migraine, and you went to see a doctor, and a bill is sent to your insurance company. Lately, you have received an explanation of benefits but didn’t know what to do. Don’t stress yourself because an EOB in medical billing is not a bill but a detailed document of your treatment expenses. In addition, a provider can consult medical billing and coding services to resolve payment issues. This article will comprehensively explain the meaning of EOB in medical billing and anatomy, explain why you’ve received it, and provide other relevant information.
Before diving into EOB’s definition, it should be clear that EOB is not a bill.
Explanation of benefits in medical billing is a document of the expenses that your provider has charged you and your payor. Basically, it works like your bank statement, in which your health insurance plan describes your treatment cost with an explanation of the services. Further, the EOB is claimed when your provider submits a claim explaining the medical services you have received.
Your EOB is not a bill but a document that provides detailed information about your treatment costs. You might get confused while reading EOB because many don’t understand its structure. Here’s the breakdown of its structure, which will erase your curiosity.
EOBs act as tools to provide your medical treatment details and all the charges, including all the hidden charges. When a care provider bills your insurance company, you will receive an EOB. Additionally, even after receiving your EOB, you’ll receive a bill if your charges remain pending. This bill is emailed to you because your payor has refused to clear the charges. It may be due to your insurance limit or any other reasonable cause. Further, EOB also tells you about the money you left in your account.
The importance of EOB in medical billing lies in the fact that you can easily track your healthcare costs. Likewise, you can easily find billing errors, tax documentation, and treatment coverage by your payor. Furthermore, it will help you analyze whether your insurance plan is correct.
The deliverable method is the significant difference between EOB and ERA in medical billing. EOB comes in traditionally because it’s a paper statement. On the other hand, ERA is delivered electronically via mail. Due to this reason, ERA reaches the provider faster, especially when the patient has made payments through EFT (Electronic Funds Transfer).
No, ABN is not similar to EOB in medical billing. Advance Beneficiary Notice (ABN) ‘s role in medical billing ensures that the provider receives the payment seamlessly, even when it is served to Medicare or Medicaid patients. Furthermore, it provides details on the services covered by the insurance. It also describes the health condition under which a patient’s insurance plan can cover the treatment.
EOB in medical billing is a report of the patient’s total medical expenditure, therefore, don’t confuse it with the bill. In case you receive a flawed EOB, contact your insurance plan and compare the bill received and the EOB sent to you. Furthermore, EOB determines the cost you owe and the cost already paid by the payor. Thus, carefully read your EOB and avoid any future inconveniences.
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