An Explanation of Benefits (EOB) is the documentation your insurance company sends to explain how your claim was processed. The insurance payment is sent to Clinical Pathology Associates and a copy of the EOB is sent to you, in order for you to determine how much you may owe. Please remember that the Explanation of Benefits (EOB) that you receive from your insurance company is not a bill. If Clinical Pathology Associates determines that your insurance processed your claim incorrectly, we will appeal that claim to your insurance company.
This is the amount charged by Clinical Pathology Associates for each test performed.
This is the amount your insurance company allows for each test before deductibles and coinsurance. Each insurance company determines their allowable rates for each participating provider.
This is the amount that must be paid by the patient before insurance will begin reimbursing for covered services. Deductibles generally must be met each year. They are accumulated for all medical services combined.
This is the portion of allowed charges that is the responsibility of the patient. Many insurance companies may require a 10%-30% coinsurance after deductibles.
A standard set amount that is due for a particular service for each visit. Sometimes co-insurance is also applied to lab charges even if a co-payment has been applied. Varies by insurance plan and insurance company.
This is the amount paid by the insurance company after all adjustments, coinsurance and deductibles have been taken out.
Contract Adjustment or Excess of UCR (Usual, Customary and Reasonable)
This is the portion of the charge that is greater than the amount allowed by the insurance company. If Clinical Pathology Associates is under contract with the insurance company, this amount is not the patient’s responsibility. If there is no contract between our lab and the insurance company, this amount is owed by the patient. “UCR” stands for usual, customary and reasonable. Each insurance company sets its own UCR. This does not mean that this test has been overcharged.
This is a charge that is excluded from your contract and is non-payable by your insurance company. Some reasons could be that the procedure is considered investigational by your particular insurance company, a non-covered diagnosis was provided by the physician office or the test has been performed too frequently for the diagnosis given. In some cases a test may not be covered by your particular plan, especially in the case of ‘Well Woman” coverage. You may be responsible for these charges and this amount will show in the patient responsibility column. The patient responsibility column is the amount you may owe Clinical Pathology Associates. This amount includes coinsurance, deductible and non-covered service amounts.