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Deciphering Your Explanation of Benefits (EOB)

Posted by Johnson Memorial Health on Jan 20, 2015 10:30:00 AM

An Explanation of Benefits (EOB) is a notification form that your insurance company sends you when a health care benefits claim has been processed. An EOB is one way that insurers can help patients manage their healthcare, and a way for patients to help their insurer verify services and control costs. Patients should carefully read and review an EOB because it provides a list of services that the medical provider or supplier claims to have provided to the patient.  

Unfortunately, unless you're fluent in "insurance-speak," EOBs can be a bit confusing. Let's take a look at some of the main sections of an EOB and how to decipher them.

EOb

A typical EOB has the following information

Patient: The name of the person who received the service. This may be you or one of your dependents.

Insured ID Number: The identification number assigned to you by your insurance company. This should match the number on your insurance card.

Claim Number: The number that identifies, or refers to the claim that either you or your health provider submitted to the insurance company. Along with your insurance ID number, you will need this claim number if you have any questions for your health plan.

Provider: The name of the provider who performed the services for you or your dependent. This may be the name of a doctor, a laboratory, a hospital, or other healthcare provider.

Type of Service: A code and brief description of the health-related service you received from the provider.

Date of Service: The beginning and end dates of the health-related service you received from the provider. If the claim is for a doctor visit, the beginning and end dates will be the same.

Charge (also known as Billed Charges): The amount your provider billed your insurance company for the service.

Not Covered Amount: The amount of money that your insurance company did not pay your provider. Next to this amount you may see a code that gives the reason the doctor was not paid a certain amount. A description of these codes are usually found at the bottom of the EOB, on the back of your EOB or in a note attached to your EOB.

Total Patient Cost: The amount of money you owe as your share of the bill. This amount depends on your health plan’s out-of-pocket requirements, such as an annual deductible, copayments, and coinsurance. Also, you may have received a service that is not covered by your health plan in which case you are responsible to pay the full amount.

Additional information may include the amount of payment actually made to your provider and how much of your annual deductible has been met. Depending on your insurance company’s EOB, the order of the information may differ.

We recommend that you keep all EOBs for at least two years. Each time you receive an EOB, review it closely and compare it to the receipt or statement from the provider. Simple errors can often be corrected by contacting the provider and/or health insurer's customer service department. However, if the EOB contains inaccuracies or discrepancies that cause a patient to question whether an honest claim for payment has been submitted, patients should contact their health insurer’s anti-fraud department to report this information.

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Topics: EOB, Insurance