An Explanation of Benefits (EOB) is a notice that your insurance company will typically send you after you have received healthcare services. Explanation of Benefits are generally mailed out once a month, and depending on the provider, they may be available online. An EOB is NOT a bill. It is a summary of items or services that you have received from your health care professional. An EOB is a great tool to use to help you examine any corresponding bills you receive for medical services. Knowing how to use and compare the two is an important skill that may save you thousands of dollars in the long run on expensive medical bills.
When you receive your EOB it should have a breakdown of:
● How much your provider billed your plan. This is the amount you would have paid
had you not been insured.
● How much your plan pays. This amount may be different from what the providers bills
because plans have negotiated rates with providers working with the plans. The plan will
only pay up to the approved amount for provided services.
● Patient Responsibility. This will be how much you may owe. Again, the EOB is not a
bill. Rather it is simply informing you of what you may owe. Your provider will send you
a bill for services received. You may be responsible for payment if you owe for a
co-payment or co-insurance, or you have not yet met your deductible. You may also be
responsible for payment if your service was denied coverage by your plan.
● EOB’s also contain important information regarding appeal rights if your plan
denies coverage of a service or items that you have received. An appeal is when
you ask your provider to reconsider its decision if they have denied coverage on services
you have received.
While an EOB may not seem important, it can be a practical means for breaking down the
services you have received as well as explaining to you your appeal rights. Make sure to read
all of the information carefully, and to contact your provider with any questions you may have.
Also make sure to contact them if there are any services listed that you do not recognize, or that you did not receive.