Explanation of Benefits

 

An Explanation Of Benefits (EOB) is a document sent by insurance companies that explains how a claim was processed. Generally, it indicates what was paid and/or what was denied. Most insurance companies use their own format for EOBs. The following table lists some common language and information found on EOBs.

Account Number

A number assigned to each bill by the provider of services. Solstas Lab Partners uses the term Accession Number. Other laboratory companies use the term "BILL#."

Allowed Charges 

The amount of the claim your insurance company has approved for processing.

Amount Paid

The portion of the total bill that has been paid by the insurance company. In most situations, this will not be the entire amount.

Claim Number 

The number assigned by an insurance company to a particular patient's bill; this number is often provided on the insurance company's response to Solstas Lab Partners.

Co-Insurance 

The portion of the allowed charges that is the patient's responsibility.

Coordination of Benefits 

Indicates the amount owed by another insurance company when the patient has additional insurance coverage.

Copay

The amount required to be paid by the patient.

CPT Code 

A code representing the service provided.

Date of Service

The date on which the testing specimen was collected.

Deductible

A specific annual dollar amount that must be paid by the patient before the patient's insurance will begin reimbursing for covered services.

Excess over UCR

The portion of the total charges that is greater than the allowed charges; this amount is based on the contractual agreement between the insurance company and Solstas Lab Partners. "UCR" stands for usual, customary and reasonable.

Explanation of Payment

The section of an EOB that details how payments were made and explains any payment codes used.

Non-Approved Amount 

The portion of the total bill that is NOT owed to Solstas Lab Partners (by the insurance company and/or the patient) when a contract exists; this amount is based on the contractual agreement between the insurance company and Solstas Lab Partners. If there is no contract between Solstas Lab Partners and your insurance provider, this column does not apply.

Non-Covered

A specific service that is excluded from a patient's coverage and is considered non-payable by an insurance company. The patient may be responsible for this amount.

Patient Information 

Various information including patient name, patient ID number, responsible party, subscriber, insured's name, employee's group number.

Patient Responsibility 

Amount patient owes provider (Solstas Lab Partners). This includes "not covered" amounts, "deductible amounts," and any percentage of balance, if payment is less than 100%. Note: Although copays are not a part of this calculation, they are also the patient's responsibility.

Provider Information 

Payee (Solstas Lab Partners') name and mailing address. Additionally, may include account number on the claim, provider number and the name of the provider.

Submitted Charges

The amount Solstas Lab Partners billed for service provided.

UCR

Stands for usual, customary and reasonable and refers to fees for services.

Units

The number of items included in this service.