How do I read my Medical Mutual explanation of benefits (EOB)

An explanation of benefits (EOB) is a document that outlines the details of a medical claim that has been processed by Medical Mutual. It provides a summary of the services that were rendered, the amount charged for those services, the amount covered by the insurance plan, and the amount that the patient is responsible for paying. Here are the steps to interpret an EOB:

• Review the patient and provider information: The first section of the EOB will include the patient's name, the provider who rendered the services, the date of service, and the name of the insurance plan. Ensure that all of this information is accurate.

• Check the services provided: The next section of the EOB will list the services rendered. Each service will be assigned a billing code, which should match the services. If you do not recognize a service or if it was not provided, contact the provider's office or Medical Mutual immediately.

• Review the billed amount: The billed amount is the total

amount the provider charged for the services rendered. It's important to ensure that this amount is accurate and reflects the services that were actually provided.

• Check the allowed amount: The allowed amount is the amount that Medical Mutual agreed to pay for the services rendered. This amount may be less than the billed amount if the provider is not in Medical Mutual's network or if the services were not deemed medically necessary. Check that the allowed amount is accurate.

• Check the patient responsibility: The patient responsibility is the amount the patient is responsible for paying, either through co-payments, deductibles, or coinsurance. It's important to review this section carefully to understand the patient's financial responsibility.

• Check the payment details: The final section of the EOB will list the amount that Medical Mutual paid to the provider and the amount the patient is responsible for paying. Ensure that the payments are accurate and that the provider has been reimbursed appropriately.

If you have any questions about the information on the EOB, or if you believe that there is an error, contact Medical Mutual or the provider's office to request more information.