Reading the Explanation Of Benefits

2d70943aae0006a3a3f6e45334c11edfOnce you have a long term care insurance claim approved, you will typically receive an EOB (Explanation of Benefits).  This document may or may not come with a check.  It is imperative that you figure out how to read this document.  A short blog is beyond the scope of helping people interpret every part of the EOB.  For that you would have to take one of our classes about “How to File A Long Term Care Insurance Claim”.

But in short, I can tell you that every long term care insurance EOB has the same parts (thought maybe not in the same place or same format!).  the parts are:  dates of service, amount billed/covered/excluded, notes.

(1)    You have to keep track of what you have sent in to the carrier and what they have noted in the Explanation of Benefits.  Any missing dates have to be re-submitted.

(2)    The amounts will usually be in multiple columns with the left-most being the amount billed, the middle being what was excluded an the right being what was approved for payment.  It isn’t ALWAYS this way…but generally so.

(3)    Notes – usually these will be listed in a column by a date of service in some arcane shorthand (like “EP” or “¥” ).  Then towards the bottom somewhere in fine print they will list this same symbol and give an explanation of what it means.  READ THESE carefully.  This is where the evil is in the details.  If these do not match your understanding of the contract in any way, it is worth calling the carrier to query these.  Items may have to be rebilled and/or there may have been amendments to the contract filed over the years by the policy owner that are not in your possession.  These amendments to the long term care insurance policy can severely modify the benefit pay out.

Keep all copies of the Explanation Of Benefits. These are your proof the benefits have paid or been duly registered/noted by the long term care insurance carrier.  If there is ever a dispute (with the carrier or with other family members!), these are valuable proof of what was approved, paid and denied.

Some other links to help you.



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