Understanding an Explanation of Benefits (EOB) Statement
An explanation of benefits (EOB) statement often arrives via mail and closely resembles a medical bill.
The EOB provides details about a medical insurance claim that has been processed and explains what portion was paid to the health care provider and what portion of the payment, if any, is the patient's responsibility. The EOB is not a bill. Any portion of the medical expense not covered by the insurance company, such as a deductible or a co-pay, will be billed by the provider and should be paid directly to the provider.
The EOB sometimes can be difficult to understand and may require a call to the insurance company to ask targeted questions about the benefits statement.
When to Expect an EOB
Every time they provide services, doctors, dentists, and other medical professionals will submit claims to patients' insurance companies to receive payment. In turn, insurance companies will send out EOBs to patients to inform them of the claims submitted, how much is being covered by the insurance company, and how much the patient owes.
Many insurance providers, such as Blue Cross Blue Shield, will have sample EOBs available on their websites. Reviewing them is a good way for patients to familiarize themselves with what EOBs look like and how to understand the information being presented.
Questions You May Have Regarding an EOB
If you don't understand why you owe money or simply are having trouble reading the EOB, call your insurance company or your healthcare provider.
If you owe money, ask the insurance company if this payment will be put toward your out-of-pocket deductible.
You may need clarification on charges for certain services rendered. You can ask the health care provider to explain the services and charges for each.
If you think you have been charged in error, ask the health care provider to go over the entire EOB, line by line, to see if a mistake has occurred.
Avoid Overpaying Medical Bills
An EOB can help you avoid paying more than you should for medical care. Look over an EOB when it arrives in the mail and compare it to your medical bills to ensure that you pay the health care provider the correct amount. If you find an error on a bill from a doctor or other health care provider, call your insurance company to address the error.
Ensuring Insurance Benefits
Just as health care providers can make billing errors, coding errors can occur when insurance companies process EOBs. If you do not understand something on your EOB or you think your insurance policy covers an expense that was not paid, call your insurance company for an explanation or to have the benefit reviewed.
Tracking EOBs Online
Policyholders with most insurance companies now have online access to their accounts, and this often includes digital access to EOBs. If you don't already have online access to your account, check with your insurance company about how to gain web access.
Once you've established an online account, check to see what options your insurer offers regarding digital access. Most will let you to sign up for email alerts when EOBs are available, allowing you to view them immediately without having to wait for them to arrive in your mailbox.
Texas Department of Insurance. "Understanding an Explanation of Benefits." Accessed Aug 3., 2020.
Blue Cross Blue Shield of Michigan. "How Do I Read My Blue Cross Blue Shield of Michigan Explanation of Benefits?" Accessed Aug 3., 2020.