Understanding Your Explanation of Benefits

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.

EOB Term	Description
Account Number	A number assigned to each bill by the provider of services; Sonora Quest Laboratories uses the term “accession.”
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.
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.
Coinsurance	The portion of the allowed charges (usually a certain percentage) that is the patient’s responsibility.
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.
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	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.
Date of Service	The date on which the laboratory testing was performed.
Deductible	A specific annual dollar amount that must be paid by the patient before the patient’s insurance will begin reimbursing for covered services.
Explanation of Payment	The section of an EOB that details how payments were made and explains any payment codes used.
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.
Patient Information	Various information including patient name, patient ID number, responsible party, subscriber, insured’s name, employee’s group number.
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.
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.
Submitted Charges	The amount Sonora Quest Laboratories billed for service provided.
Units	The number of items included in this service.
UCR	Stands for usual, customary and reasonable and refers to fees for services.