Visiting the doctor can be a stressful experience. Whether you scheduled an appointment because of an ailment, or you are there for a well-check, the doctor’s office tends to make people feel vulnerable. With changing healthcare regulations and insurance policies, understanding the costs related to visiting the doctor can help ease some of the burden.
When you visit the doctor, depending on the type of insurance policy you carry, you may be asked for a copay. This is usually required when you check in for your appointment. After your appointment is over, the practice will collect payment from your insurance company, and then bill you for the amount your insurance doesn’t cover.
As a patient, you will receive an explanation of benefits (EOB) after your insurance has been billed. This will outline the services and costs your insurance company paid for, and the amount that you are responsible to pay for. An explanation of benefits can be difficult to understand, but there are a few things you should check to make sure you are billed correctly. While little things on an EOB may not seem like a big deal, mistakes in addresses, location of services, or services performed can cause your insurance company to reject the claim or take extra time to process.
- Enrollee Name – the name of the policyholder, not necessarily the patient
- Patient – the name of the person who receives the services
- Provider Name – the name of the doctor or practice that administered
- Claim Number – the number assigned to the claim by your insurance company
- Enrollee Address – the address of the policyholder
- Date of Service – when the services were rendered
- Place of Service – the location where the patient received services
- CPT Code – a universal code that identifies the service provided
- Charge Amount – amount charged by the provider
- Allowed Amount – amount previously determined for the cost of services
- Not Covered – cost beyond the allowed amount, usually to be paid by the patient
- Reason Code – an explanation of why service has been denied
- Deductible – the amount a patient must pay before the insurance company pays
- Benefit Amount – percentage at which the amount covered will be paid by the insurance company
- Due from Patient – the amount the patient is responsible to pay