An EOB is a document sent by insurance companies that explains how a claim was processed. Generally, it indicates what was paid and/or what was denied. Most insurance companies use their own format for EOBs. The following table lists some common language and information found on EOBs.
| Term |
Description |
| Amount Paid |
The portion of the total bill that has been paid by the insurance company. |
| Allowed Charges |
The amount the insurance company approved for processing. |
| Capitation Accounts |
These are clients (HMOs, IPAs, physicians, etc.) who generally pay a fixed rate based on a number of members per month and/or volume of tests. Capitated clients usually provide services for HMOs. |
| Claim Number |
The number assigned by an insurance company to a particular patient’s bill; this number is often provided on the insurance companys response to Quest Diagnostics. |
| Coinsurance |
The portion of the allowed charges (usually a certain percentage) that is the patient’s responsibility. |
| Contract Charges |
The portion of the total bill that is NOT owed to Quest Diagnostics (by the insurance company and/or the patient); this amount is based on the contractual agreement between the insurance company and Quest Diagnostics. |
| Coordination of Benefits |
Indicates the amount owed by another insurance company when the patient has additional insurance coverage. |
| Copay |
The amount required to be paid by the patient. |
| Date of Service |
The date on which the laboratory testing was performed. |
| Deductible |
A specific annual dollar amount that must be paid by the patient before the patient’s insurance will begin reimbursing for covered services. |
| Excess over UCR |
The portion of the total charges that is greater than the allowed charges; this amount is based on the contractual agreement between the insurance company and Quest. "UCR" stands for usual, customary and reasonable. |
| Explanation of Payment |
The section of an EOB that details how payments were made and explains any payment codes used. |
| IPA |
Independent Practice Association |
| Non-covered |
A specific service that is excluded from a contract and is considered non-payable by an insurance company. The patient may be responsible for this amount. |
| Patient Information |
Various information including patient name, patient Id number, responsible party, subscriber, insured’s name, employee’s group number. |
| Patient Responsibility |
Amount patient owes provider (Quest Diagnostics). This includes "not covered" amounts,"deductible amounts," and any percentage of balance, if payment is less than 100%.Note: Although copays are not a part of this calculation, they are also the patient’s responsibility. |
| Provider Information |
Payee (Quest Diagnostic’s) name and mailing address. Additionally, may include account number on the claim, provider number and the name of the provider. |
| Service Code |
A code representing the service provided. |
| Submitted Charges |
The amount Quest Diagnostics billed for service provided. |
| Units |
The number of items included in this service. |
| UCR |
Stands for usual, customary and reasonable and refers to fees for services. |