Understanding Your Explanation of Benefits (EOB) for Pediatric Therapy

Written on May 8, 2020

Understanding your Explanation of Benefits: Understanding your Explanation of Benefits (EOB) for Children’s Speech, Occupational or Physical Therapy is important to ensure that your insurance is working. And above all, to eliminate surprises that result in unexpected expenses.

Keeping track of denials: Many times the insured (you)  gets the EOB in the mail before the provider (BDI). Therefore, if you see something that doesn’t look right, you can call your insurance or your pediatric therapy billing office right away, before you accumulate a large bill you might not be prepared for.

• Look for accuracy: It is in your best interest to watch your EOBs from your insurance to verify services are accurate. Noticing an error can be brought to your provider’s attention sooner so it can be corrected immediately.    
• Reading an explanation of benefits (EOB) from your insurance for your child’s pediatric therapy can be a little confusing at times. Some pediatric therapies use the same or similar codes for treatment. These are called CPT codes. A CPT code is the code assigned to the therapy to describe the type of therapy your child had.
• The office will bill a set rate (or charge) to your insurance for those CPT codes. If our company has a contract with your insurance; a discount might be offered and included on your EOB. Based on your benefits, you would be responsible for any unmet deductible, coinsurance, or copay. 

1-What services were performed.

2-The amount that was billed to your insurance.

3-Your insurance allowed this amount for that service, based on our contract with them, if any.

4-The amount your insurance paid the company based on your policy benefits.

5-Name of the organization that was paid for the service (BDI, or Bautz Developmental Intervention)

6-What your financial responsibility is for this date of service based on your policy benefits. (This would be deductible, copay or coinsurance portion.)

7-The reason for any non-payment or adjustment (reduction in payment) that was made. 

Our goal is to make funding for your insurance as stress-free as possible. If you need additional help, we are only a phone call or email away! Our patient families can reach us at office@bdiplayhouse.com or 708-478-1820.

Written by:

Ann Marie Johnson

BDI Playhouse Insurance Billing Specialist and Assistant Office Manager