Understand your EOB
EOB stands for “explanation of benefits.” It’s a detailed breakdown of the coverage and costs associated with a service. It details the date and type of the service, and then gets into the costs.
- Amount Billed by Provider: This is the full cost of the service.
- Payments from Other Insurance: Shows whether any of the cost is covered by another insurance if you have other coverage.
- Approved Amount for MESSA Payment: The power of MESSA’s vast network allows us to negotiate lower costs for services. In this case, the billed amount is $345.94, but the amount negotiated with the provider is $172.97.
- Participating Provider Savings: The difference in savings between the amount billed and the negotiated amount.
- MESSA Payment: The amount MESSA pays toward the approved amount, based on the member’s health plan.
- Deductible: The amount a member must pay before MESSA starts to pay for covered services.
- Copayment: A fixed amount a member pays toward a covered service.
- Coinsurance: A percentage a member pays toward a covered service.
- Amount not Eligible for MESSA Payment: Any out-of-network services you may receive.
- Remark Code: Shows how a claim was processed.