A few weeks after a session, you may receive an Explanation of Benefits (EOB) document from your insurance company. This looks like a bill, but it isn't. Instead, it outlines and explains the services you received.
What is an EOB?
An explanation of benefits (EOB) is sent to you by your health insurance company to inform you that a claim has been processed for the care you received. It's meant to help you understand how much each service costs, how much your plan will cover, and typically how much you may have to pay when you receive a bill. EOBs should help clarify the following:
The cost of the care you received
What portion of the cost your insurance company covered, including special member discounts or preferred member rates
Any out-of-pocket expense you may be responsible for
The EOB is not a bill. It simply reflects how your insurance processed your claim. You do not need to take any action on your EOB.
How do I read my EOB?
EOB documents vary from one insurer to the next but typically include multiple sections that outline specific details for each claim by date. The information contained in these sections usually aligns with these areas:
Service Description describes the health care services you received, like a medical visit, lab tests, screenings, surgery, or lab tests.
Provider Charge(s) is the amount your provider bills for your visit.
Allowed Charge(s) is the amount your provider will be reimbursed, negotiated between the carrier and the provider.
Paid by Insurer is the amount your insurance plan will pay to your provider.
Payee is the person who will receive any reimbursement for overpaying the claim.
What You Owe is the amount the patient or insurance plan member owes after your insurer has paid. You may have already paid part of this amount, and payments made directly to your provider may not be subtracted from this amount. Wait to receive a bill from your provider before paying for the services.
Remark Code is a note from the insurance plan that explains more about your visit's costs, charges, and payment amounts.
An additional overview resource and example are available from the Centers for Medicare & Medicaid Services here.
Why is the amount so large?
An EOB includes a charge rate from Grow Therapy. The charge rate is the highest amount on the EOB and is typically listed under Amount Billed. This charge rate, a.k.a. billed amount, is not your responsibility.
Once your claim is processed, you will only be charged the amount you owe. This is typically your copay or coinsurance rate. You will be charged the full member rate if you have a high-deductible plan and still need to meet your deductible.
How does claim processing work?
After each session, a claim that includes the "charge rate" between $180-350 is automatically sent to your insurance company for processing. Processing typically takes 3 to 4 weeks, after which the insurance company will send you and Grow Therapy an EOB. An EOB shows how much of the insurance rate, aka member rate, will be split between you and the insurance company.
In the example below, the session cost totaled $162, and the insurance company states they will cover $122 of it while you are responsible for a $40 copay. Grow Therapy would charge $40 to your payment method on file.
How will I know how much I owe?
After your first claim is processed, like the one above, you'll know how much your cost per session will be. You could be charged a copay, coinsurance, or towards your deductible. Every plan has its own benefit guidelines, which can get confusing quickly. Use this article to help you better understand your coverage.
If you are charged towards your deductible, you will be charged this amount until your deductible is met, after which you will be charged a copay or coinsurance amount. Generally speaking, if you are charged a copay or coinsurance, you will be charged that amount until your out-of-pocket maximum is met, after which you will not be charged!
This video by Kaiser gives a great overview. Remember that if you have a deductible-based plan that restarts at the beginning of the year, you may be charged the full member rate until you reach your deductible.