Understanding Explanation of Benefits for Mental Health Providers

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Are you letting your money slip through the cracks?

Understanding how much a client owes from insurance and co-pay will help ensure you are receiving the full payment for services rendered.

Here’s a helpful breakdown of the basics of an Explanation of Benefits and the important costs you should be receiving from your insurance and clients.

What is an Explanation of Benefits?

An Explanation of Benefits is a statement from the health insurance company you typically receive after submitting a claim.

It summarizes the amount of money paid by your insurance company as well as the patient of the insurance company.

Key Definitions to Keep in Mind

Interpreting an Explanation of Benefits can be complex. Here are the key definitions you should pay extra close attention to:

  • Amount Charged – The full amount you would charge to a private-pay client. This amount is agreed upon in your contract with your insurance credentialing panel.
  • Amount Adjusted – This is the difference between the full-price amount charged and your contracted rate specifically for the CPT code for the services you’re filing for.
  • Contracted Amount / Amount Allowed – The contracted rate of the CPT code for the services you provide your patient.
  • Co-payment / Co-Insurance / Patient Responsibility – This is the amount your patient owes you for the services rendered.
  • Payable Amount/Amount Paid – The actual amount being paid by the insurance company.

Pay Extra Attention to the Co-Pay

When it comes to mental health billing, one of the biggest errors stems from a lack of understanding of how patients’ co-pay amounts are factored into the equation. Mental health professionals often disregard that a patient’s copay is actually a part of the overall sum they are getting paid.

For example, let’s say the insurance paid out $60 and the patient’s co-pay is $20. You may feel disappointed that you’re “only getting $60” for your services, but in reality, once you collect the $20 at the time of service, the total you received is $80.

Are You Stressed About Your Mental Health Billing?

Why not offload your mental health insurance hassle to a team of experienced billing professionals at Anchor Point Billing Solutions? Save time, increase revenue, and focus on doing what you love – caring for your patients.

Connect with us to learn more about how we can help provide a seamless billing experience for you and your patients.

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