Example of an EOB (Explanation of Benefits):

An EOB is a statement from your insurance company detailing what services were billed, how much was covered, and what you owe. Here’s a simplified example:

Patient Name: John Doe
Service Date: 01/01/2024
Provider: XYZ Medical Center

Billed Amount: $200
CPT Code: 92507  (office visit)

• Allowable Amount: $85.00

• Adjusted Amount: $115 (billed amount subtracted from allowable amount)

• Deductible: $1,000 (not yet met)

• Copay: $20 (for office visits)

• Coinsurance: 0% after deductible

Payment Breakdown:

• Total Amount Billed: $300

• Insurance Payment: $0 (if deductible not met and it applies)

• Patient Copay: $20

• Patient Coinsurance: $0 (deductible not met)

Total Patient Responsibility: $85.00 until the deductible is met.  

**Once the deductible is met, $20.00 per session. 

**If the deductible does not apply to the billed service code, then the amount would be $20.00

Each insurance plan has its own rules, so it’s essential to check the specifics of your policy.  It is important that you understand your medical insurance plan.  TPE is not responsible for knowing the details of every plan.