coinsurance – KR2 Medical Billing

Everyday I receive at least 10 phone calls from patients freaking out about a “bill” they received from their insurance company. No it is not a “bill” just an EOB.

What is an EOB? EOB stands for Explanatiin of benefits. Its a piece of paper or papers that have a couple of components to it.

Fist listed is the DOS (date of service or visit). Then the codes that your provider has billed or submitted to your insurance company. Next is the POS (place of service). So far so good, right…you still with me?…Yes?..OK. Now come the billed charges-the amount that your provider billed your insurance company. Then the allowed charges-what your insurance will pay. Next column will show any amount that will go towards you deductible or coinsurance – this is your responsability and you have to pay that given amount to the provider. Then you will see the non covered changes- self explanatory. You still following me?…OK. we are almost at the end….LOL

There are also the numerical expalantion codes (reason codes)-explaining why this was paid and why not. Last but not least is the column of paid amount: the amount that was paid to your provider for the services billed.

Please remember that it is NOT a BILL….only an explanation of your benefits that you would receive after your provider submits a claim to your insurance company.

I hope this will help you in understanding about EOB. If you do have any other further questions please feel free to contact me via email or my contact form on my page and I will be glad to assist you. (You will receive an answer within 1 business day)

Insurance World can be confusing! Deductible? Out of pocket Costs? HSA account? Omg! Overwhelming! But I am here to help you 🙂
Although there are slight differences between services that your insurance covers,the general idea is the same.

Currently, I work for a doctor’s office as a Lead Medical Clerk. I deal with Insurance Q&A on daily basis 🙂

Lets first look at what a deductible is. My husband used a car insurance example to explain this to my mother in law.
-When you buy Ins coverage for your car,you can select a deductible amount-what is your responsibility is (cash) that you would pay before the insurance covers the rest.The same principle applies to medical insurance. When you have a deductible with your medical plan that just means that you need to pay a specific amount of money before insurance company starts covering your services at 80% INS/20%PT, 70%INS/30%PT or 90%INS/10%PT.
This brings me to the next topic:coinsurance (examples above). Coinsurance is the amount you are responsible for, after you satisfy your deductible. You pay this amount until you meet your out of pocket costs
Out of pocket Costs is the amount of money you have to pay,for services rendered a year. After this set amount is met the insurance company covers you @100%. ! Yay 🙂 Unfortunately, OOP costs could be high and it could take you a while to pay them….
Fortunately, some people might have a thing called HSA account to help them with the high OOP costs or high deductible. This is offered by your employer -a certain amount of $ goes towards medical expenses, medications or any other medical related expenses that your plan doesn’t cover. Just make sure to let your provider know that you have a HSA account and that way you can use the HSA debit card or the money can be taken out of the account. This prevents any future billing issues. ! 🙂
Ok, I hope you guys feel more comfortable with this topic.
Till next time, Kate

Tag: coinsurance

What is an EOB?….a scary monster?…LOL

Common Insurance questions simplified :)

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