What is an Explanation of Benefits (EOB)?

After your visit, you will receive an Explanation of Benefits (EOB) from your insurance provider. Just a reminder that the EOB is NOT A BILL or dollar amount that you owe, but rather a document letting you know that a claim procedure has started between Family First ER and your insurance company. There is no need to get stressed out over the amount you may see. Even though it says you may owe X amount, we will negotiate with your insurance company, and we will NEVER send you a balanced bill from your visit.

Have more questions? Please feel free to reach out to us at (346) 437-9888.

Why is the Billing Process so Complex?

The medical billing process may seem confusing, but there’s no need for panic or frustration. After you receive emergency care, our invoice specialists will contact your insurance carrier on your behalf. We let them know about the costs of the medical treatment(s) you received at our medical facility. This ensures you receive all the indemnities of your health plan without paying hefty out-of-pocket expenses. It can take some time, but this process helps you maximize your insurance benefits. At the ends of the claims process, most patients will owe considerably less than the amount listed on the EOB. Most of our patients do not owe anything at all.

The purpose of the EOB is not to confuse you – it is for transparency about your medial services and to show the value of your health insurance plan. It may also show you the status of any accounts you have related to your health insurance plan.

What Exactly is an Explanation of Benefits?

As mentioned above, an EOB is sent by health coverage insurers to contact patients. This is standard practice in the medical insurance claims industry. Here are some essentials to keep in mind.

  • The EOB will state the name of the healthcare center where you received treatment(s). It will list all the medical services you received and which services were covered. The EOB states the amount that MAY be owed as patient responsibility – this amount depends on your specific insurance plan and the amount of assistance the insurer provides.
  • For out-of-network medical facilities, the EOB will still list the total fees. If you visited our facility, you can check our insurance page for more details on billing. Remember, insurance companies will send out the EOB before the final cost is determined, so the last amount due on the claim may or may not coincide with the amount you owe (if any).
  • Determining the actual cost owed by the insurer will take some time. Since we are out-of network with your insurance company, there are not pre-negotiated set prices for service.  We are working on your behalf to have your insurance company pay on your claim.  The EOB will notify you on what services you received, but the actual bill (if any) will come later.
  • At Family First ER, you will never be charged for more than what we collect. This is based on an agreed price equivalent to fair in-network cost and the amount(s) your insurance health coverage needs. As a patient, you do have rights under the No Surprises Act that protects against surprise medical bills. If you have questions, please contact the No Surprises Help Desk at 1-800-985-3059 or visit ww.cms.gov/nosurprises/consumers.

Some of our competitors charge patients with surprise costs and bills. At Family First ER, we believe in honesty, integrity, and upfront information for all our patients. This is why we are the ideal choice for all your emergency care needs.