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Understanding Mental Health Insurance: Part 2 – How to Read Mental Health EOBs (Explanation of Benefits)

This short video screencast will use real explanation of benefit documents to reveal how to read and understand mental health EOBs.

You keep getting them in the mail and they might as well be written in hieroglyphics.  Mental health EOBs aren’t actually overly complex, they just require knowing how the math works out.

Watch our Video Screencast to Walk Through Example EOBs

Mental Health EOB Math 101

  • Amount Charged:
    • Your full-price private pay fee, often agreed upon during your insurance credentialing process.  If you have agreed upon a specific full-fee price with a specific insurance company, you must use that price when filing claims with that insurance company.
  • Amount Adjusted:
    • This is the difference between the full-price amount charged and your contracted rate specifically for the CPT code (procedure code) for the services you’re filing for.
  • Amount Negotiated / Contracted Amount / Amount Allowed:
    • This is the agreed upon contracted rate of the CPT code for the services you provide your patient.  Each CPT code has its own contracted rate.
  • Copayment / Co-Insurance / Patient Responsibility:
    • This is the amount your patient owes you, often paid during each in-office session.
  • Amount Paid:
    • This is the difference between the allowed amount for the CPT code you’re claiming and the patients responsibility.

That’s it!  Please review the video for specific examples.

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