Explanation of Benefits (EOB): What is It and Why is it Sent?

Our GeneSight® customer care team often receive two billing-related questions:

• What is an Explanation of Benefits (EOB)?
• Why does my EOB say I owe more than I was told during my estimate?

We’ll dive into the answer to the first question in this blog post. On the second, we reiterate the GeneSight promise: “We promise that if your cost could be more than $330, we’ll contact you before we process your test.” You don’t owe more than you were told.

So, if you won’t owe more, why might you get a piece of paper in the mail with a different price? Let’s start by understanding what an EOB is and what it is not.

An EOB is not a bill

Quite simply, an Explanation of Benefits (EOB) is a statement provided by health insurance companies to policyholders.

“Your health insurance company will process our claim, then send you an EOB within 30-45 days. This is not a bill that you pay,” according to the Cost page on GeneSight website. “The EOB or Explanation of Benefits is a detailed explanation of the amount your insurance has covered for the GeneSight test(s). Most EOBs require no action.”

The EOB is often sent after a medical claim has been processed by the insurance company, serving as a communication tool to inform the policyholder about how the claim was handled.

Components of an EOB

The format of and information contained on EOB can change depending on the insurance company. However, each EOB should state “Explanation of Benefits” on the top of the page.

Typically, EOBs will start with patient information – your name, policy number, date of service, etc. They will also likely include provider details – who offered the service and contact information.

The EOB will also include a service description, which “explains what service you had, like a medical visit, lab test, or screening,” according to the Centers for Medicare & Medicaid Services (CMS) website. For example, the EOB for a GeneSight test may be labeled as a “laboratory” expense.

Other components on the EOB will include dollar figures – amount covered by the insurance plan, including any deductibles, co-payments, or co-insurance; payments and adjustments; and provider responsibility.

However, to underscore, this statement is NOT a bill.

Why do insurance companies send an EOB?

One of the main reasons that insurance companies send EOBs is for transparency. They give the details of services and allow patients to understand the costs associated with their healthcare.

Patients have the ability to review and ensure that the provider accurately accounted for the services submitted to the insurance company. In case of any discrepancies, the EOB can serve as basis for communication between the patient, healthcare provider, and the insurance company.

Unless we have a contract with your insurance company for a specific coverage fee, we bill your insurance according to guidelines set by the American Medical Association (AMA) using approved CPT® (Current Procedural Terminology) codes for the genes involved in the pharmacogenetic testing process.

CPT was designed by the AMA to standardize reporting of medical, surgical, and diagnostic services and procedures performed in inpatient and outpatient settings. Each CPT code represents a written description of a procedure or service.

Will I get a bill from GeneSight?

Depending on your insurance carrier, you may receive a bill after you’ve taken the GeneSight test. It will not be more than the cost we quoted to you.

The GeneSight test bill will say “Patient Statement.” It will provide payment options as well as the amount owned. It will be reimbursable to Myriad Neuroscience (the GeneSight test is made by Myriad Neuroscience, a division of Myriad Genetics) and the address will be a PO Box in Cincinnati, Ohio. A bill may also refer to Assurex Health, which was the predecessor to Myriad Neuroscience.

We’re here to answer questions

We know insurance can be complicated. We want you to feel comfortable knowing what you’ll owe. We promise that if your cost could be more than $330, we’ll contact you before we process your test to discuss our financial assistance program and interest-free payment plan and give you the chance to cancel. More than 98% of patients pay $330 or less for their GeneSight test.*

If you have any questions about your EOB or patient statement, please don’t hesitate to contact us at 866.757.9204 and [email protected].

For more information about similar topics, please visit:

• https://genesight.com/cost/
• The GeneSight billing process
• The Mental Health Price of Holiday Overspending