What Is an Explanation of Benefits?

What Is an Explanation of Benefits?

1000 667 Jennifer Nelson

So you recently had an MRI or brought your child in for a measles vaccination, and now you’re receiving something called an explanation of benefits (EOB). What is this document all about, and what do you have to do with it?

What Is an EOB?

Your insurance company will send this statement for every health care visit, procedure or test you undergo. It’s not a bill. Instead, it’s your insurer’s written clarification regarding what they paid for the treatment or procedure and what, if anything, you’ll have to pay.

Your insurance company sends EOB statements as an administrative task while processing the bill for your medical care. The statement is for your benefit: It’s an important document to ensure that you’re being billed correctly, that your procedure was coded accurately and that your financial responsibility is correct. Keep these statements in a safe spot until the bill has been completely settled, in case there’s any discrepancy.

How to Read Your EOB

Your EOB will include the name of your provider, the date of service, the service provided and relevant charges, both covered and not, such as copays, deductibles and coinsurance. Make sure that all information is accurate. Also, read any codes on the back for why a service or procedure was denied. Common codes include:

  • Out-of-network provider.
  • Service is not a covered benefit.
  • Invalid code, indicating an error.

Finally, check the math to ensure there are no clerical errors. An added zero or a misplaced decimal point can mean a world of difference to your bank account.

If you find a mistake or are not sure about something on your explanation of benefits statement, call your care provider and check with the billing clerk. If you did not receive the services or equipment listed on your EOB, call your insurer.

Jennifer Nelson

Jennifer Nelson is an award winning health, health IT, and personal finance writer.

All stories by:Jennifer Nelson

Jennifer Nelson

Jennifer Nelson is an award winning health, health IT, and personal finance writer.

All stories by:Jennifer Nelson