Understanding Your Explanation of Benefits (EOB)

For the past few years since moving from Virginia to Columbus, my father has allowed me to take over paying his bills. Each month, along with his checkbook, he hands over the EOBs he has received that month from his insurance company, with payment amount circled with his red ink pen, which he believe he owes. Every month I explain that just as printed on the top of each statement, it is not a bill, but that it is an Explanation of Benefits. One day I thought I should ask what he had done with the EOBs he received while living in Virginia. He said “I’ve paid them.” I had him show me how he had determined what to pay, and quickly learned he had been giving money away, paying the amount of the bill before his two insurance companies had paid their portion.   After a few inquiries, it was apparent that he just needed to move forward and there was no way to recover the money he had paid out already, especially since it had been a couple of years.

Have you ever considered paying the amount listed on your EOB?   Do you have friends who have or who consider it? I hope the information below will help you and those close to you when you receive your next EOB in the mail. According to most insurance companies that I talked to, here are things you should know. An Explanation of Benefits (EOB) is a notification form provided by your insurance company when a healthcare benefit claim is processed on your behalf. The EOB displays the expenses submitted by the provider and shows how each claim is processed.

The EOB has four major sections:

  • Claim Information includes the member and patient name, the member’s group and identification numbers, and the claim number.
  • Summary highlights the financial information – the amount billed, total benefits approved and the amount you may owe the provider.
  • Service Information identifies the health care facility or physicians, dates of service and charges.
  • Coverage Information shows what was paid to whom, what discounts and deductions apply, and what part of the total expense was not covered.

The EOB may also include additional information:

  • Information About Amounts Not Covered will show what benefits limitations or exclusions apply.
  • Information about Out-Of-Pocket Expenses will show an amount when a claim applies toward your deductible or counts toward your out-of-pocket expenses.
  • Information about Appeals explains your rights regarding review or claim denials.
  • Fraud Hotline is a toll-free number you can call if you think you are being charged for services you did not receive or if you suspect fraudulent activity.

Your EOBs are always available, and if you would rather contact your insurance company by phone, you will find their 800-number listed on the back of your insurance card. Remember — don’t reach for your checkbook until you are sure of the exact amount of your out-of-pocket cost.

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