When you or your family member goes to the doctor for a checkup, lab work, or other medical tests or procedures, you should receive an Explanation of Benefits (EOB) in the mail. An EOB is not a medical bill. It is an itemized statement that includes the healthcare service you received, how much was charged for the service, what was paid by your insurance carrier, and what you are expected to pay out-of-pocket.
When you first look at an Explanation of Benefits, you may feel a little intimidated by all the information listed there. Even if the document confuses you, don’t ignore or discard it. It’s important to take steps to understand your EOB. Here is a list of the most common information you will find on your EOB statement and how to read it.
Member: This will include your contact information or the contact information for a member of your family who received care. The group number on your insurance card will also appear here.
Summary of services. This lists the medical services that you or your family member received. This will also list any charges that you may owe and that were not paid for by your insurance company. If you do receive a medical bill, it’s important to compare the bill to the EOB. You’ll want to make sure that you are being billed for the correct services that you or your family member received.
Summary of deductibles and copayments. This column shows you how much of your copays and deductibles you’ve paid to date.
Details of services. This explains what type of care was received, the date of the appointment and the provider’s name. This is very important information to keep on hand. If you receive a medical bill, make sure the healthcare provider on the bill, as well as the date and the type of service received, match the same information on the EOB. Errors are not uncommon, and it’s possible that the bill and the EOB may not match. In order to notice and handle billing errors quickly and efficiently, you should always keep your EOB on file so that you can compare it to your bill.
Allowed amount: This is the contracted amount of payment a provider has agreed to accept for a service, treatment or product from an insurer. In network providers can collect up to this amount, but out of network providers may balance bill up to their charges.
Still feeling a little confused about your EOB? If you are a Health Advocate member, call us—a Personal Health Advocate can help you better understand your EOB. If necessary, your Personal Health Advocate can also help you resolve any errors you may find on your EOB or medical bill.