Finding the right health insurance coverage for you and your family is simple enough. Check the online insurance rates, provide the necessary information, receive your health insurance quotes, and pick the plan that’s most cost effective for you. The next step is understanding your Explanation of Benefits.

The Explanation of Benefits is a statement that details the amount your provider and you pay on the claims you make. It typically includes the provider, date and type of service, the submitted charges, the amount negotiated or allowed, the amount pending or not payable, your co-pay, your deductible, the amount remaining to be paid, the percentage paid by your provider, the dollar amount paid by your plan, your share of the amount remaining, and your total patient responsibility. It seems more complex than it is.

The provider, date and type of service are simply the name of the doctor or hospital, the date you were seen, and the type of service you received. (Type of service could be anything from medical/surgical supplies to an office visit.) Submitted charges are the total charged by the provider. Negotiated or allowed is the amount your plan, in accordance with the health insurance quotes you received for those online insurance rates, will pay for that type of service in the area you live in. The amount pending or not payable will generally include an explanation at the end of the statement. Your co-pay is the amount you are required to pay at the time of service. It might be $15 for an office visit and $50 for an urgent care visit. Your deductible is the amount you are must pay each year before your coverage pitches in. If you’ve met the deductible, this column will be blank. At the start of the year there’s an amount in this column until your deductible is met. The amount remaining to be paid is the sum of what’s not payable, your co-pay, and your deductible. The paid at % is then applied to the amount remaining to calculate the amount your plan pays. Your share of the amount remaining is the difference between the amount remaining and what the plan pays. If your plan pays the amount remaining at 100%, your share will be nothing. You’ll still be responsible for your co-pay at the very least. At the most you’ll be responsible for the sum of the not payable amount, your co-pay, your deductible, and your share of the amount remaining.

Once you’ve gone over the Explanation of Benefits a few times, it will be easy to understand why you’re required to pay the amount stated