Based on the presented Explanation of Benefits, I found certain areas difficult to understand. For instance, there are places where the covered amounts are less than the billed amount. This could only mean that a discount has been given. I do not understand why or how the insurance companies would give discounts despite covering a large part of the patients’ care. Another area that I found confusing stems from the tag "This is Not a Bill." Despite indicating that this is not a bill, several procedures have been billed, including procedures such as X-ray, emergency operations, and laboratory.
The patient must be in a position to understand what was paid and not paid by their insurer. They must first begin by appreciating the insurance plan that covers their health. I would let them know that whatever that has been paid was part of the initial contract they had with the insurer. However, what was not paid for means that the patient must consider an out-of-pocket payment. Patients must understand the provisions of their insurance plans, including exempted care procedures. In most circumstances, many private insurance companies do not cover underlying conditions such as diabetes and cancer.
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Cigna’s EOB appears to more comprehensive with more services covered. Compared to CMS, Cigna has few amounts not covered. However, the copay deductibles for CMS are higher than that of Cigna. The rest of the aspects in the EOB appear to be similar.
The EOB picked for analysis is Cigna. There is a difference between the amount billed, allowed, and paid because Medicare covers part of the expenses, and the rest is catered to by the patient. The amount allowed and paid is also less the discounted value provided by the insurance company. The patient portion is the amount of money the patient ought to pay. In this case, it was copay because Medicare-covered part of the bill.
