Every EOB you contains information about services you received from that specific provider during a particular visit. A provider is anyone who supplies healthcare and/or other medically related services and products. A provider may be a physician, dentist, clinic, hospital, pharmacy, lab, physical therapists or other health care professional. Looking at your EOB, you should see the name of the provider or facility that filed the claim for reimbursement listed. A service is a procedure or product rendered by a provider to a patient. A service could range from a basic physician visit to radiology services to surgical care or medical equipment. The date on which you received services from a provider is called the service date.

Billed Amount

This represents the cost of the services you received and the amount the provider sent to your insurance company. It should be the largest figure on your EOB.

Network Discount

This is the amount by which a providers bill is adjusted as a result of a negotiated rate agreed upon between the provider and the insurer, and is not always listed on an EOB. This only applies to in-network providers.

Allowed Amount/Covered Amount

The allowed amount is the amount of payment a provider has agreed to accept for the service, treatment or product under the terms of a negotiated contract with an insurance company. This applies only to in-network providers. The allowed amount may also be the maximum amount the insurance company will allow for a specific service.

Insurance Amount/Paid

As you may have already guessed, this is the amount that your insurance company pays on a claim.

Deductible Amount

Your deductible indicates the portion of expenses that count toward your plan deductible and you are responsible to pay.

Patient Responsibility

This is the portion of the provider charges to be paid by the patient after the network discount, allowed amount, insurance portion and deductible amount have been taken into account. Basically, this is what you are expected to pay out-of-pocket for the services your received.

The Math

The key to understanding comes down to identifying four numbers: the provider charges (amount billed from doctor, hospital, etc.), the discount (which is based on the negotiated rate of your individual plan coverage), what insurance paid and patient responsibility.

The amount the provider sent to your insurance company as their “charge” or “billed amount” should be the largest figure on the EOB. Next, find and subtract the “discount” to arrive at the allowed amount, which is the amount your insurance company and your provider agree is the fair amount to be paid. If you do not have a discount amount displayed, simply locate the allowed amount on your EOB.

Now look at the amount your insurance paid. It can be anywhere from $0 to the full allowed amount. Subtract what the insurer paid from the allowed amount. What’s left is the patient responsibility. To double check the math, add together the amount the insurance paid and the patient responsibility, it should equal the allowed amount, sometimes referred to as the negotiated rate.

Remember, the patient responsibility may NOT be the balance owed to your provider, depending on if the insurance company reflects your payments already to the provider (such as co-pays, pre-payments and any other payments you have submitted). If payments you have previously made are NOT reflected on the EOB, you will need to subtract your payments from the patient responsibility amount to figure out the balance owed to the provider.

EXAMPLE:

Billed Office visit $155.00

Allowed Amount $ 93.03 (Network Discount $61.97)

Plan Pays $83.73 (Insurance Paid)

Patient Responsibility $ 9.30

Visit http://MedicalBillConsultants.com for more information and learn how they can advocate in your behalf with you medical providers.

Rich Davis is a partner with Medical Bill Consultants, Tarzana, Ca. Medical Bill Consultants provides medical bill review service to consumers of medical service who question the high bills they receive. Medical Bill Consultants works on a flat fee rather then a high contingency providing money back guarantee. Visit their site http://DiscountMyMedicalBill.com for more information.

Article Source: http://EzineArticles.com/?expert=Rich_Davis

Our government has recognized that it is very important to care for its elderly citizens. That is the reason why Medicare health insurance was created. Anyone age 65 or older is eligible for this government health care plan. For many that are eligible, Medicare can be very confusing because it has many parts.

To put it simply, Part A covers any costs for impatient hospital care. Most of those who pay Medicare taxes from paychecks receive Part A for free and automatically.

Part B includes some doctors’ services and outpatient care-but it is not free. Part B requires a minor monthly premium.

Part C deals with various health care options, like HMOs, that are approved by Medicare but are not related. Part C allows for a private insurance company, through a government contract, to reside over all of your Medicare benefits. Part C also requires additional costs that can vary widely.

Part D was created to cover prescription drugs. This plan is controlled by private companies that are Medicare-approved. It is also optional and costs more money.

The “original” Medicare plan was comprised of only Parts A and B. Later, the “advantage” plans of Parts C and D were added, and with a higher cost. Parts C and D had to be created because parts A and B did not pay for everything.

Medicare has created Medicare supplement plans to ensure that all costs can be paid and it is a type of private insurance. Most of the costs these plans cover are deductibles and co-payments that can add up very quickly for seniors on fixed incomes. The supplement plans have been termed “Medigap” because the plans were created to cover the “gaps” in costs for procedures that are not always included in Medicare. Medicare supplement insurance is standardized and regulated by the U.S. government. You can obtain a supplement plan through insurance companies and you must choose which insurance company you want by the price of their supplement plan. This is true because each plan covers the same things-no matter what insurance company you receive it through.

“Medigap” insurance is regulated by the Federal government and insurance companies must also follow state laws. Due to different laws, the plans can vary slightly state by state. To add to the complexity of Medicare, there are 12 different types of standardized Medicare supplement insurance. They are designated letters of A through L, so it can take a great amount of time to figure out which supplement plan fits your needs.

Sadly, many Americans do not receive health insurance. This dilemma is often due to high insurance rates and prolonged, or even small, illnesses that can clean out an underinsured person’s savings. This results in medical bills that may never be paid off. The key is to have a plan in these situations. Even with the outrageous healthcare costs in this country, it is vital to plan properly if you were to need medical attention. No insurance that is truly affordable will ever be able to cover all healthcare costs. So, you must evaluate your circumstances and your anticipated needs. Due to the fact that medical needs may come up suddenly, it is recommended that you obtain Medicare supplemental insurance.

About The Author

Tom Carolan

Buying Shopping for health insurance can leave many people confused. Knowing which insurance company to choose or which insurance plan is the best may seem daunting impossible. But once you know the basics of health insurance, choosing the right health insurance plan is simple easy.

This article will provide some of the most basic and helpful tools and explanations for health insurance shoppers. First, it is important to learn about helps to understand the different types of health insurance plans and their benefits and drawbacks. Plans differ in the amount you pay out-of-pocket, which doctors you can visit, and how the your insurance bills are paid. Besides just helping you choose the most efficient and cost-effective plan, we’ll teach you about another way you can save on health insurance: a Health Savings Account. Additionally, it is important to learn about dental insurance as well. Many health insurance plans do not include dental insurance under their benefits, so we’ll go over how to shop for and obtain separate dental coverage. Then it is important to learn about ways you can save on health insurance. There are several ways you can save including Health Savings Accounts and Discount Cards. LastlyAnd finally, don’t forget to compare plans before you make your decisionwe’ll explain why it’s so important to put your new knowledge to good use by comparing health insurance plans.

Types of Health Insurance Plans

Health Maintenance Organization (HMO) Plans

Generally, HMOs have low or even no deductible and the co-payments will be relatively comparatively low as well. You pay a monthly premium that gives you access to coverage for doctor appointments, hospital stays, emergency care, tests, x-rays and therapy. You will have to choose a primary care physician (PCP) within your insurance provider’s network of physicians, and in order to see a specialist you need to receive a referral from your PCP. Under an HMO plan, only visits to doctors and hospitals with the insurance company’s network of providers are covered; you’ll have to pay for visits if you go to an out-of-network doctors or hospitals your insurance will not cover the costs.

Preferred Provider Organization (PPO)

Plans Under a PPO plan, you will use the insurance company’s network of doctors and hospitals for any services or supplies you need. These healthcare providers have been contracted by the insurance company to provide services at a discounted rate. Generally, you will be able to choose doctors and specialists within this network without having to choose a primary care physician or get a referral. Before the insurance company will start paying for your medical bills you will usually need to pay an annual deductible. Also, you may have a co-payment for some services or be required to cover a percentage of the total medical bill.

Point of Service (POS) Plans

A POS plan is a combination of the features offered by HMO and PPO plans. You are required to choose a primary care physician, whose services are not usually subject to a deductible, but your PCP can refer you to out-of-network specialists whose services will be partially covered by your insurance company. Additionally, POS plans usually offer coverage for preventive healthcare, which includes regular checkups. Your PCP will be able to give you referrals for any specialists. If these specialists are out-of-network you will need to pay out-of-pocket and then apply for reimbursement from the insurance company. With a POS plan you will benefit from some of the savings of an HMO and will have greater flexibility in choosing healthcare providers, similar to PPO.

Dental Insurance

It is important to get a dental insurance plan along with your health insurance plan. In order to keep your teeth and gums health you need regular visits to the dentist. Without dental insurance, the cost of dentist appointments will be much higher making it difficult to keep up with the payments. Dental insurance is similar to health insurance in that each month you pay a premium, which entitles you to certain dental benefits. Benefits include checkups, cleanings, x-rays, and other dental services. There are plans that may cover dental implants, oral surgery and orthodontia, but they will be more expensive. Like health insurance, plans are categorized into indemnity and managed-care plans. If you choose an indemnity plan you will have a broader choice of dental care providers to choose from. You won’t have to choose one primary dentist and generally, you won’t need to acquire referrals. In order for the insurance company to cover your dental expenses you will need to send them a claim before they reimburse you for covered services. As a result, you will have to pay more out-of-pocket with an indemnity plan, but you will have more flexibility in choosing which dentists you visit. On the other hand, managed-care plans will provide you with a dental provider network and you will need to visit dentists within this network in order to get coverage for these services. With a dental care network, the insurance company has arranged pre-negotiated rates that you will receive when you visit these dentists. With a managed-care plan, the dentists will submit the claim for you, lowering your out-of-pocket expenses.

Save on Health Insurance

Health Savings Account

Health Savings Accounts (HSA) are tax-free savings accounts designed to help consumers pay for healthcare services while limiting premium expenses for unwanted benefits. The plans have lower premiums and higher deductibles than other insurance plans because they offer fewer benefits and require you to use the money in your HSA to pay for certain qualified medical services. However, if you don’t need to visit the doctor frequently and don’t anticipate requiring regular medical attention, HSA plans are a cost-effective method of insuring against the worst without paying for coverage you won’t use. In order to open an HSA, you’ll need to have an HSA-compatible health insurance plan. You may only use the funds in your HSA to pay for qualified medical expenses. Usually, your HSA plan will have a deductible that, once met, requires your insurance company to pay for any additional qualified medical expenses for the rest of the year.

Dental Insurance

Health insurance typically does not cover dental services, but in order to keep your teeth and gums healthy, you need regular visits to the dentist. Without dental insurance, regular dentist appointments can prohibitively expensive. Make sure your mouth is covered by shopping for both health and dental insurance. Dental insurance is similar to health insurance in that each month you pay a premium, which entitles you to certain dental benefits. Benefits include checkups, cleanings, x-rays, and other dental services. There are plans that may cover dental implants, oral surgery and orthodontia, but they will be more expensive. Like health insurance, plans are categorized into indemnity and managed-care plans. If you choose an indemnity plan you will have a broader choice of dental care providers to choose from. You won’t have to choose one primary dentist and generally, you won’t need to acquire referrals for special services. In order for the insurance company to cover your dental expenses you will need to send them a claim for reimbursement. You’ll end up paying more out-of-pocket with an indemnity plan, but you will have more flexibility in choosing which dentists you visit. By contrast, managed-care plans limit you to the doctors and services within a dental services network, and you will need to visit doctors within this network in order to get coverage for their services. Within the dental care network, your insurance company has arranged pre-negotiated rates that you will receive when you visit dentists in the network. Your dentist will submit your insurance claim for you, keeping your out-of-pocket expenses lower than with an indemnity plan.

Compare the Plans

Comparing insurance plans is an important step in buying health insurance. It will save you money in the long run if you take the time to compare premium prices, out-of-pocket costs, plan benefits, the network of physicians available with different plans, and the quality of insurance providers. If you have a favorite physician, make sure your health insurance covers visits to him or her. If you don’t need to see the doctor very often, don’t pay a high premium for low office visit copayments. Health insurance plans are designed to address specific healthcare needs, and you’ll save money and get the most effective coverage by comparing plans to find the health insurance plan that best fits your budget and lifestyle.

About The Author

Julie Madison