Your EOB is a statement of what the insurance company paid for your treatment.
What can I learn from an EOB?
Every time you visit a health care professional and use your health insurance benefits, you’ll receive an EOB in the mail a few weeks later. Today, they frequently are available online as well.
Every company’s EOB has a different look, but they all generally contain the same basic information:
- Date of the visit and the doctor or facility you visited
- Services you received
- Amount your health care provider submitted to the insurance company for the services
- “Allowed” amount, which is the discounted rate the insurance company negotiated with providers for covered services
- Amount you saved by visiting an in-network provider or facility
- Amount paid to the provider by the insurance company
- Deductible paid or owed by the patient. The deductible is what you pay for eligible services before your plan begins to pay.
- Coinsurance is the cost sharing of allowable charges by you and the insurance company after you’ve met your deductible.
- Patient responsibility, which is the amount the patient owes
What should I do with an EOB?
Make sure the information is accurate. Even though the document lists an amount as the patient’s responsibility, an EOB is not a bill. The care provider also received its version of an EOB and will send you a bill based on what the insurance company did and did not cover. When you receive the medical provider’s bill, check it against the EOB to make sure it matches the amount the EOB says you owe.
With the proliferation of high-deductible insurance plans, many medical offices are estimating what your expected out-of-pocket expense will be and require some or all of the amount upfront. In those instances, you may not get a bill from the provider. If you pay in advance for any services, make sure you get a receipt and see that the amount you paid matches the amount the insurance company says you should have paid.
Paying attention to EOBs is especially important if you had a hospital stay. You might see many health care providers who bill your insurance separately. For one minor operation, you could end up with separate EOBs from an attending physician, an anesthesiologist, the hospital, the hospital’s pharmacy and a surgeon, for instance.
Mistakes?
With the millions of medical codes and prices being generated, mistakes can happen. Call the insurance company right away if you suspect a problem. Sometimes it’s immediately obvious—the doctor billed for the wrong procedure, for instance—and other times it might take more paperwork with the insurance company to correct.
However, if the information on your bill and EOB match but it is more than you thought you would have to pay, see if there is a “remark code” next to any items on the EOB. The code will explain why the insurance company denied a charge. If your benefits were not applied correctly, the company can reprocess your claim. If the issue can’t be explained to your satisfaction, every insurance company has an appeals process that you can follow to dispute the claim.