4 Things To Know About Your Explanation of Benefits (EOB)

A lot of people get confused when they receive the Explanation of Benefits (EOB) for their group or personal health insurance, only because it frequently comes in the mail. If it’s not something related to billing, they just think it’s superfluous and throw it away.

However, you shouldn’t throw away your EOB, as it will give you concrete details of what your insurance covers—and what it doesn’t cover.

Then again, it’s not quite as simple as that either. If you run a business and need health insurance for you or your employees, it’s essential you read what the benefits are. You might be surprised to find that some of it is different from what you signed up for, so it’s worth reading every word.

The best designed EOB forms give you simple, easy-to-find contact information so you can talk to someone if you see something amiss. You should get full entitlement of the benefits you paid for, and your EOB should list them all.

Nevertheless, you have some highlights to look out for if you only have time to skim. Here’s four things to know about your EOB, and what they mean so you clearly understand everything.

1. Specifics of Services or Procedures

The first thing you’ll typically see on your EOB is information on services you signed up for, or procedures you’ve already had. Most forms will have a description about the type of medical services that took place, followed by a code number, plus the date you had the services done.

When you receive your EOB, it’s smart to keep it in your records because of the details available about the medical procedures taking place. If there’s any type of confusion or mistakes, you can prove it with the EOB form you received.

As always, if you see something that doesn’t look right, call your insurance company to get it corrected. Making assumptions that they have everything correct could equal a loss for you or your company, since mistakes are more frequent than you think.

2. Understanding Billing Information

Even though your EOB form isn’t a bill, you’ll see a detailed list of your services and what your insurance agreed to pay. They’ll frequently list this as “billed”, or what your medical provider billed your insurance. You’ll see another column next to the one above showing what your insurance agrees to pay based on that billed amount.  The next column will show amounts not paid, which is the discount offered as a result of using an in-network provider.

Again, it’s worth keeping this for your records if you discover any discrepancies in what you actually pay later.

3. Describing Your Co-Pays, Deductible, and Co-Insurance

Most EOB’s have a middle section describing the details of your insurance plan. You’ll see information on what kind of co-pays you have (something that varies with provider), plus your deductible. The latter can get confusing, but it’s important to know that it’s always expressed in a total amount for the year.
Depending on the plan design, you will see your patient responsibility in the last column.  This number should be used to match the bills received from your provider.

4. The Possibility of Reimbursement Check

Sometimes you’ll receive an EOB form that has a check attached if you happened to overpay a health care provider. Be sure to read your EOB carefully for this reason alone, since throwing it out could mean the loss of reimbursement.

As mentioned above, far too many people mistake EOB’s for a bill. Your actual bill won’t arrive until well after receiving your EOB, where you’ll get a more direct view of what you’ll actually pay. If you have employees covered under a group health insurance plan, it might be a good idea to share this information with them so they too are aware.