Explanation of Benefits (EOB’s) from International Medical Group (IMG) may commonly arrive in your mail each month! Though they come in different forms, they all contain the same general information. The post below is an overview of the new color EOB’s that IMG recently rolled out.

Provider: This is the name of the doctor or facility that has submitted the claim.

Date Of Service & Service Code: The date the service was provided and an internal code from IMG.

Total Charge: The dollar amount submitted by the provider to IMG.

Not Covered: Charges for all non-covered items on the bill, if any.

Reason Code: The reason for the non-covered service would be coded here and explained in the Remark Code Description box at the bottom of the EOB.

Discount Amount: If the provider was stateside and in-network there may be a discount applied. This box reflects the dollar amount discounted from the total charges.

Covered By Plan: The amount of the claim that is eligible for processing by IMG.

Less Deductible: For stateside claims a $750 deductible is applied each year. This is the amount of the claim eligible for processing after applying the deductible.

Less Co-Pay: Reductions in benefits are recorded here. These charges would include things like, additional deductible for using the emergency room and not being admitted, or reduction in benefits for being out of network.

Amount Subject To Coins: Reflects the amount of the claim that is subject to 80/20 co-insurance. If in the processing of this claim, you meet your co-insurance for the year there may be a second line item showing a zero amount.

Paid At: This box shows the percent of coverage for the line items directly to the left. They will show 0%, 70%, 80% or 100% under normal processing.

Less Patient Share Of Coins: This is the amount of co-insurance that IMG is applying to the claim (your portion).

Payment Amount: After deductible and co-insurance are applied, the is the amount of the claim that IMG is approving for payment are posted here.

Total Payment: This is the sum of all the line items and the dollar amount of the check issued to the provider or you in the case of an international claim.

Patient’s Responsibility: The green box on the left is an estimate of what IMG believes you will owe based on the claim submitted and the processing of the charges.

NOTE: Never pay a provider from the Patient’s Responsibility on the EOB. Wait until you receive a bill from the provider. If the amount on the bill and the Patient’s Responsibility match you are good to pay the provider. If the amounts don’t match, there is an issue that needs your attention.

Remark Code Description: Always review this section! If a claim is pended, it will usually be for further information like an itemized bill, missing receipts, or other information necessary to process the claim.

Accumulator: The last piece of information are the accumulators for your deductible and co-insurance. This will show where you are for the year on these out-of-pocket expenses.

Please don’t hesitate to contact me mduff@bbfimissions.com if you have questions.