EOB Explanation of Benefits Post Medical Visit Form

The (EOB) explanation of benefits form comes from your health insurance company.  You should get an explanation of benefits mailing if you have a private health insurance plan, a public (Medicare) health insurance plan, or a health insurance plan your employer chose.  An explanation of benefits (EOB) is a form sent to you by your insurance provider several months after you had a health care service paid by the plan.

Insurance plans exist as large groups of people who all pay in to a fund.  In exchange for the opportunity to be reimbursed for service from this large group, hospitals and clinics deliver care at a lower rate.  The insurance plan negotiates a lower rate of reimbursement with the hospital and clinic providers in exchange for steering the people who pay in to the collected fund for service.

Below is an example of an EOB after a clinic visit with the primary MD about 1 week after a hospital discharge.

Patient:  (name here) Liddy Kass

Insurance ID number: 51 Number assigned to Liddy by her private insurance plan

Claim number: 88 Number assigned to this claim by her private insurance plan

Provider: Marcus Welby MD Name of Liddy's Primary medical doctor

Type of service: Post hospital follow up office visit

Date of service: 01/23/13 day Liddy had an office visit with Dr. Welby

Charge: 150.00 the amount Marcus Welby billed Liddy's private insurance plan

Not covered amount: 75.00, the amount of Dr. Welby's bill that Liddy's private insurance plan will not pay.  The code next to this was 260 which was described on the back of Liddy's EOB as "over what plan allows". 

Total patient cost: 10.00 Liddy's office visit copayment

Amount paid to provider: 65.00 the amount that Liddy's private insurance plan sent to Dr. Welby

The arithmetic: Dr. Welby is allowed 75.00 (his charge of 150.00 (minus) the non covered amount 75.00 (equals) 75.00.  Dr. Welby gets 10.00 from Liddy and 65.00 from her private insurance plan.

The EOB form demonstrates how collected information is diminished and refined for ease of conveying along the system.  Names, codes, numbers, and classifications, are stored and accessible in
the digital medical operating system.  The system values how the visit is recorded as an occurrence.

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