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.


  1. How would you explain what an Explanation of Benefits form is?
  2. How would you explain the difference between the amount submitted and the amount allowed?
  3. 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.
  4. 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
Type of Service:Office Visit
Amount Submitted:$82.00
Amount Allowed:$74.00