Final answer:
The term for the written report that insurers provide to the insured regarding payment details of a claim is called an Explanation of Benefits (EOB). It includes essential financial details like the deductible, co-insurance, and co-payment and is crucial for understanding insurance coverage and out-of-pocket expenses.
Step-by-step explanation:
In the healthcare industry, the term for the written report that insurers use to notify insureds about the extent of payments made on a claim is called an Explanation of Benefits (EOB). This document is critical for both the insurer and insured, as it outlines the costs billed to the insurance company and shows the portion of the bill for which the patient is responsible. The EOB typically includes details such as the deductible, co-insurance, and any co-payment amounts.
The EOB will also illustrate how each service was covered under the terms of the insurance policy, including any discounts that were applied due to network agreements with providers. The insurer’s share and the patient's out-of-pocket expenses are clearly listed, allowing individuals to understand the financial aspects of their medical care and to ensure that their insurance benefits have been accurately applied.
An EOB is essential in fee-for-service and Health Maintenance Organization (HMO) plans. In a fee-for-service setting, the EOB will detail payments based on the services provided, whereas, in an HMO, the focus would be on the services received under the fixed-amount paid for the patient enrolled.