Understanding an Explanation of Benefits
Advanced English listening exercise · Health Insurance
Transcript
[Agent] MediCare Plus, this is Tom. How can I help you? [Caller] Hi Tom, I received an Explanation of Benefits statement and I'm confused by all the numbers. Can you help me understand it? [Agent] Of course! An Explanation of Benefits, or EOB, is a summary of how we processed your claim. It's not a bill — it's an explanation. Let me walk you through each section. [Caller] The total charges say twelve thousand dollars. Did I really owe that much? [Agent] No. That twelve thousand is the amount the hospital billed, which is their standard rate. Look at the next column — "allowed amount." That shows what we negotiated with the hospital, which is seven thousand five hundred. [Caller] So the hospital accepted forty-five hundred less? [Agent] Exactly. That's the network discount — the benefit of using in-network providers. The hospital has agreed to accept our negotiated rate as full payment. [Caller] Okay, then there's a line that says "plan paid" at six thousand. [Agent] That's the portion your insurance covered. After the allowed amount of seventy-five hundred, we applied your remaining deductible of five hundred, then covered eighty percent of the rest. [Caller] So the five hundred was my deductible? [Agent] Correct. And the remaining thousand is your coinsurance — your twenty percent share of the sixty-five hundred remaining after the deductible. [Caller] So I owe fifteen hundred total? [Agent] Yes — five hundred in deductible plus one thousand in coinsurance. The hospital will send you a bill for that amount. If you need help with payment, most hospitals offer payment plans. [Caller] That's so much clearer now. Can I get this in writing? [Agent] You already have it! The EOB you received breaks down all of these numbers. The "patient responsibility" line at the bottom is what you'll owe.
Comprehension questions
- According to Tom, what is an EOB?
- What is the network discount?
- What is the total amount the hospital billed?
- What is the remaining deductible mentioned in the conversation?
- What is the 'coinsurance' amount the caller has to pay?