An 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.
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EOB Term |
Description |
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Account Number |
A number assigned to each bill by the provider of services; Sonora Quest Laboratories uses the term “accession.” |
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Amount Paid |
The portion of the total bill that has been paid by the insurance carrier. |
|
Allowed Charges |
The amount the insurance company approved for processing. |
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Capitation Accounts |
These are insurance companies (HMOs, IPAs, etc.) who generally pay a fixed rate based on a number of members per month and/or volume of tests. Capitated payors usually provide services for HMOs. |
|
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 Sonora Quest Laboratories. |
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Coinsurance |
The portion of the allowed charges (usually a certain percentage) that is the patient’s responsibility. |
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Contractual Allowance |
The portion of the total bill that is NOT owed to Sonora Quest Laboratories (by the insurance company and/or the patient); this amount is based on the contractual agreement between the insurance company and Sonora Quest Laboratories. |
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Coordination of Benefits |
Indicates the amount owed by another insurance company when the patient has additional insurance coverage. |
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Copay |
The amount required to be paid by the patient. |
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CPT Code |
The Current Procedural Terminology (CPT) code set is a medical code set maintained by the American Medical Association through the CPT Editorial Panel which describes the laboratory services that were performed. |
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Date of Service |
The date on which the laboratory testing was performed. |
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Deductible |
A specific annual dollar amount that must be paid by the patient before the patient’s insurance will begin reimbursing for covered services. |
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Explanation of Payment |
The section of an EOB that details how payments were made and explains any payment codes used. |
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Non-covered |
A specific service that is excluded from a patient’s policy plan coverage and is considered non-payable by an insurance company. The patient may be responsible for this amount. |
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Patient Information |
Various information including patient name, patient ID number, responsible party, subscriber, insured’s name, employee’s group number. |
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Patient Responsibility |
Amount that the insurance has indicated the patient owes provider (Sonora Quest Laboratories). This includes "not covered" amounts, "deductible amounts," and any co-insurance, if payment is less than 100%. Note: Although copays are not a part of this calculation, they are also the patient’s responsibility. |
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Provider Information |
Payee Sonora Quest Laboratories name and mailing address. Additionally, may include account number on the claim, provider number and the name of the provider. |
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Submitted Charges |
The amount Sonora Quest Laboratories billed for service provided. |
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Units |
The number of items included in this service. |
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UCR |
Stands for usual, customary and reasonable and refers to fees for services. |
Pay at Time of Service
Pay a discounted rate for many laboratory services when paying at the time of service.