What is an Explanation of Benefits (EOB) Statement?

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An Explanation of Benefits (EOB) statement often arrives via mailĀ and closely resembles a medical bill.

The EOB provides details about a medical insurance claim that has been processed and explains what portion was paid to the health care provider and what portion of the payment, if any, is the patient's responsibility. The EOB is not a bill. Any portion of the medical expense not covered by the insurance company, such as a deductible or a co-pay, will be billed by the provider and should be paid directly to the provider.

The EOB sometimes can be difficult to understand and may require a call to the insurance company to ask targeted questions about the benefits statement.

Some Questions You May Have Regarding an EOB

If you don't understand why you owe money or simply are having trouble reading the EOB, call your insurance company and/or your health care provider.

If you owe money, ask the insurance company 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 EOB when it arrives in the mail and compare it to your medical bills to ensure you pay the health care provider the correct amount.

If you find an error on a bill from a doctor or other health care provider, call your insurance company to address the billing error.

Ensuring Insurance Benefits

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