Assignment 5 Explanation Of Benefits
Using your textbook and the Internet, submit your answers to the following questions on a Word document in the appropriate drop box.
Questions:
- How would you explain what an Explanation of Benefits form is?
- How would you explain the difference between the amount submitted and the amount allowed?
- After you explain the amount allowed to her, she gets irate and exclaims, “How dare Dr. Simmons overcharge me by $8.00!” She then said that she was going to call his office and give them a piece of her mind.
- How will you respond to this?
As a patient advocate, you frequently receive questions regarding bills. A patient called today and asked you to explain a form that she received from her insurance company. She said the form was called an Explanation of Benefits. She said that Table A-1 provided the following information:
Table A-1 Explanation of Benefits Information
| Provider: | Dr. Theodore Simmons |
| Date: | 11/11/11 |
| Type of Service: | Office Visit |
| Amount Submitted: | $82.00 |
| Amount Allowed: | $74.00 |
| Coinsurance: | $14.80 |
| Deductible: | $300.00 |
| Copay: | $20.00 |
