What Is an Explanation of Benefits?

What You Need to Know About EOB

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An Explanation of Benefits (EOB) often arrives in your mailbox and it closely resembles a medical bill.

Before you start shouting and frantically calling your healthcare insurer about what you might think is a bill for medical services rendered, take time to look at the EOB, which actually gives you details about how your insurance company processed medical insurance claims.

The EOB tells you what portion of a claim was paid to the health care provider and what portion of the payment, if any, you are responsible for.

If you have to meet an insurance deductible or have a co-pay toward medical services rendered that was not paid at the time of service, your medical practitioner will likely mail you a bill. This uncovered medical expense is paid directly to the provider.

While the EOB is an "explanation," sometimes it's hard to understand, and therefore, may require you to call your health care provider and ask targeted questions about the benefits statement.

Some Questions You May Have Regarding EOB

If you don't understand why you owe money or simply are having trouble reading the EOB, call your provider.

  • If you owe money, ask 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 EOBs when it arrives in the mail and compare it to your medical bills to ensure you pay the medical provider the correct amount. If you find an error on a bill from a doctor or other health care provider, call your health care insurance company to explain that your EOB shows that insurance paid on the claim and you have a billing error.

    Ensuring Insurance Benefits

    Just as your health care providers can make billing errors, coding errors can occur when EOBs are processed by your insurance company. 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.

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