![]() ![]() ![]() In addition, no individual will be denied coverage based on race, color, religion, national origin, sex, sexual orientation, marital status, personal appearance, political affiliation or source of income. Also, you may have received a service that is not covered by your health plan in which case you are responsible for paying the full amount.No individual applying for health coverage through the individual Marketplace will be discouraged from applying for benefits, turned down for coverage or charged more premium because of health status, medical condition, mental illness claims experience, medical history, genetic information or health disability. This amount depends on your health plan’s out-of-pocket requirements, such as an annual deductible, copayments, and coinsurance. Total Patient Cost: The amount of money you owe as your share of the bill.Even if you've met your out-of-pocket requirements for the year already and don't have to pay a portion of the bill, the amount the health plan pays is likely a smaller amount than the medical provider billed, thanks to network negotiated agreements between insurers and medical providers (or in the case of out-of-network providers, the reasonable and customary amounts that are paid if your insurance plan includes coverage for out-of-network care and you've met your out-of-network deductible already). Amount the Health Plan Paid: This is the amount that your health insurance plan actually paid for the services you received.The difference is indicated in some way on the EOB, with either an amount not covered, or a total covered amount that's lower than the billed charge. Insurers generally negotiate payment rates with healthcare provider, so the amount that ends up being paid (including the portions paid by the insurer and the patient) is typically less than the amount the provider bills. A description of these codes is usually found at the bottom of the EOB, on the back of your EOB, or in a note attached to your EOB. Next to this amount you may see a code that gives the reason the healthcare provider was not paid a certain amount. Not Covered Amount: The amount of money that your insurance company did not pay your provider.Charge (Also Known as Billed Charges): The amount your provider billed your insurance company for the service.If the claim is for a healthcare provider visit, the beginning and end dates will be the same. Date of Service: The beginning and end dates of the health-related service you received from the provider.Type of Service: A code and a brief description of the health-related service you received from the provider.This may be the name of a doctor, a laboratory, a hospital, or other healthcare providers. Provider: The name of the provider who performed the services for you or your dependent.Along with your insurance ID number, you will need this claim number if you have any questions about your health plan. Claim Number: The number that identifies, or refers to the claim that either you or your health provider submitted to the insurance company.This should match the number on your insurance card. Insured ID Number: The identification number assigned to you by your insurance company.This may be you or one of your dependents. Patient: The name of the person who received the service.
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