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Now that I’ve shown you what an EOB looks like, let’s go over a few more.Below is one from Aetna which shows that I was allowed to receive .60 for a 99213 (again follow up visit, low complexity) in March of last year.Take a moment to think about that: not only does your doctor have no idea how much you might pay for the medications he prescribes you or how much that test he ordered for you will cost, he doesn’t even know how much he’s paid to see you in his office.If you didn’t think medical finances in this country were surreal before, that should convince you.What’s more, Blue Shield is only responsible for .69 of the .69 they approved. So the EOB provides both a partial payment (if I’m lucky) as well as a set of guidelines for how I might collect the rest of what they say I’m owed.As you can already see, the insurance companies have created a rather confusing process for collecting an amount of money that, in many cases, would barely be enough to fill the gas tank of an SUV.Here’s how EOBs work: If a healthcare provider—hospital, lab, physician, whoever—provides a medical service and bills the patient’s insurance company, the insurance company will respond with an EOB.The EOB explains what service we are paid for, how much we will be paid, who pays (the patient or the insurance company) and what was denied or not allowed.
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Before I do, though, I’ll introduce you to what an explanation of benefits (EOB) is.
An EOB is a statement each insurance company sends each medical provider every time that provider bills for a service.
There is a lot of confusing information on this document but, bear with me and I’ll walk you through it all.
Under the heading “procedure number” (to the right of “dates of service”) you see the number 99213.