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Week 8 Assignment 1: Understanding an Explanation of benefits (EOB)
1. Explain briefly, in your own words, what an EOB is and what it is used for.
2. Look at the SurgiCenter of Smith County (Line 1) and answer the following:
a. If the allowable charges are equal to the amount of the bill LESS (minus) the amount you do not owe, calculate the amount the insurance is allowing for the procedure.
b. How much did the insurance company pay the provider for the procedure?
c. How much does the Patient owe the provider for the procedure?
3. Look at the City Physician Group Charges (line 2) and answer the following:
a. Does the patient owe a Co-Pay for these services?
b. Did the insurance company pay anything for this procedure?
c. Using the same formula as 1a above, if the insurance company would have paid for these services what would have been the allowable charge for this service.
4. For this EOB (all services) answer the following:
a. What was the total amount (out of pocket expense) that the patient was responsible for paying?
b. What was the total the Insurance Company paid all the providers?
c. What is this patients Coinsurance maximum for the yearly period?
d. Did this patient meet their yearly deductible?
e. What was the amount of the yearly deductible that they needed to meet?
