Do you have questions about your Explanation of Benefits (EOB)? Understanding an EOB will help take the guesswork out of how your insurance benefits apply to services received at Rula. This article will explain what is an EOB, typical information found within an EOB, claim processing steps and timelines, and how much you owe based on the EOB.
What is an EOB?
An Explanation of Benefits (EOB) is a document provided by your health insurance company after you've received medical services or treatment. It outlines the costs associated with the services you received, how much your insurance will cover, and how much you're responsible for paying out-of-pocket. Essentially, it explains the details of how your insurance benefits were applied to the healthcare services you received.
What is the typical information contained on an EOB?
EOBs from different payers may contain different information or be presented in different formats. But typically the following information can be found on your EOB:
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Patient Information: Your name, policy number, and the date of service are usually at the top of the EOB.
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Service Details: This section lists the medical services you received, including the date, the provider's name, and a brief description of the service or treatment.
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Provider Charges: The amount the healthcare provider billed for the services rendered. This is often referred to as the "provider's charge" or "billed amount."
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Allowed Amount: The maximum amount your insurance company will cover for each service, based on your policy and negotiated rates with healthcare providers. This is also known as the "contracted rate" or "negotiated rate."
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Insurance Payments: The portion of the allowed amount that your insurance company pays to the healthcare provider on your behalf.
- Patient Responsibility: The amount you're responsible for paying directly to the healthcare provider, including deductibles, copayments, and coinsurance.
See Understanding your insurance coverage for more information on common health insurance terms like copay and deductible.
Why do I see SUD - Speciality Group or MHSG (Mental Health Specialty Group) vs. Rula?
You may notice on claims or explanation of benefits (EOBs) note the billing provider as SUD Specialty Group, MHSG (Mental Health Specialty Group) or Rula. Here’s why you may see these variations:
Legal Entity Names
- SUD Specialty Group - CA: In California, we operate under the legal entity name SUD.
- MHSG (Mental Health Specialty Group): Outside of California, we operate under the legal entity name MHSG, which stands for Mental Health Specialty Group.
Doing Business As (DBA) Name
Regardless of whether the mental health practice operates under SUD or MHSG, both entities use the name Rula.
Claim processing
We strive to ensure that your healthcare billing process is as seamless as possible. This article explains the steps involved in submitting claims after your healthcare provider documents the encounter, including the timelines for copay charges and insurance processing.
Key Timelines
- Provider Documentation: Typically, completed within 72 hours of the visit (but could be longer)
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Copay / Coinsurance Charge: After documentation is complete and claim is submitted
- If a copay or coinsurance amount was identified during our VOB process it will be charged upfront before the claim is processed by insurance
- Claim Submission to Insurance: Shortly after documentation is complete
- Insurance Processing: 3-4 weeks on average (could be longer)
- Patient Charges Post Insurance Processing: Additional charges beyond copays and coinsurance may be identified after insurance processes the claims - most commonly, this would be a client’s deductible. These may be charged to the client's credit card on file post insurance adjudication.
How much do I owe?
Based on the EOB, we retrieve the amount you owe. This amount is based on the insurance company’s processing and includes any copays, deductibles, and coinsurance as specified in your plan.
We charge your credit card on file or send you a bill for the amount due based on insurance processing.
If you have questions regarding how your insurance processed your claims, please reach out to the payer directly. Rula provides an initial estimate during the verification of benefits process, however your responsibility will be determined based on actual claims processing by your insurance.
Additional Resources
- What do we need from you to properly bill a claim? - walks you through the CMS 1500 form with each required field and the corresponding details needed to process claims efficiently.
- Common Insurance Denials - explains the Coordination of Benefits process when using multiple insurance policies, and walks you through common denial scenarios.