Explanation of Benefits
After you get care, your provider sends a bill, or “claim,” to your insurance company. Your insurance company handles the claim and sends you an Explanation of Benefits (EOB). The EOB is a summary of the services you received and the date they were performed, how much your provider charged your insurer and how much your insurer paid. The EOB may also include the amount you have paid toward your deductible.
An EOB is not a bill, so you should not make any payments based on this information. You will get a bill from your provider or hospital if you owe a balance.
Is the EOB related to a claim for which you already paid the provider? If so, it may contain a reimbursement check. In that case, you will see an area on the EOB labeled “payment enclosed” or “issued amount.” Be sure to cash the check promptly and to keep the remaining part of the EOB for your records.
Most EOBs start with identifying information specific to you and your plan, and list the services you received. If any of this information is wrong, contact your plan. If you have questions about your EOB, talk to your plan. If you believe that your claim was not resolved the right way, tell them. The phone number is on the EOB.
If, like millions of Americans, you have a health plan that allows you to receive out-of-network healthcare, you have probably received an “Explanation of Benefits” (EOB) from your insurer. Many people don’t understand this form, and because it includes a notice that it is “not a bill”, they discard it. But if you don’t pay attention to your EOBs, you may not get the maximum value of the health benefits you are entitled to receive.
The video on this page provides a detailed explanation of how to read and understand your EOB.
Don’t Make Payments Based on an EOB
Remember, don’t make any payments based on the EOB – it is not a bill. If you haven’t already, you will receive a bill from your provider or healthcare facility for the amount you owe.
If the EOB relates to a claim for which you already paid the provider, it may contain a reimbursement check. If that is the case, you will see an area on the EOB labeled “payment enclosed” or “issued amount.” Make sure that you don’t throw away your EOB without removing this check!
If you have questions about your EOB, or believe that your claim was not resolved properly, contact your plan. The phone number is right there on the EOB.
While the EOB may be complicated, understanding it can help ensure that you and your family get the most out of your health insurance!