This Is How You Should Read Your Health Insurance EOB

You might have heard of EOB or Explanation of Benefits, but knowing what it implies is necessary. An EOB is a statement that is forwarded by a particular health insurance company to any covered individual. Thus providing them with a detailed explanation of what medical services or treatments were added on their behalf. EOB documents contain health insurance-related information that’s extremely private. Besides this, it will also have information on the claims that were rejected along with the reason for rejection. If you want to know how you should read your health insurance EOB, you must know in detail what Explanation of Benefits stands for. Go through the points mentioned below.

Explanation Of Benefits – What Is It?

When you visit a doctor or a health care provider, you may be asked about the payment process. This means you can choose for your insurance company to pay for the service or pay it out of your pocket. In case you opt for that, the medical office will file the health insurance claim and forward it to your health insurance company. This insurance claim is a request to your provider to pay for your visit, medical treatment, and medical equipment.

As soon as the claim reaches the insurance company, they will carry out a thorough evaluation of the claim, prepare an EOB, and then mail you the details. You will be receiving an Explanation of Benefits, irrespective of whether you are availing private insurance, your employer’s insurance, or Medicare. It doesn’t matter whether you owe any amount for the availed service or not. You are automatically entitled to an EOB. You wouldn’t be receiving an EOB, only if the health insurance plan you are on is an HMO.

Don’t Mistake an EOB as a Bill

Even though an EOB declares the expenses you are accountable for, don’t consider it as a bill. The EOB is entirely for your reference and nobody else’s. A bill is a statement that you receive from your health insurance provider. Your insurance company has got nothing to do with it. You might need to shell out an up-front payment which is generally charged by some providers.

However, the amount will be reimbursed by the insurance company. There is, in fact, nothing to be worried about and no reason whatsoever to mistake an Explanation of Benefits as a bill.

What Does an EOB Comprise?

Coming to what an Explanation of Benefits includes, all the information like the name of the individual who availed the service, the health insurance ID, claims number, and the details of the health care provider. In addition to that, it also has details like the services, date, and cost of services the individual has availed. The EOB will also inform you whether the sum you must spend, will get applied to the deductible or not. Aside from that, you will come across the term and conditions, detailed information regarding how to appeal for a certain claim, etc.

How Do You Read EOBs?

You must go through your EOBs once they arrive at your doorstep. The EOBs are essential documents that intimate you with all the important aspects that are related to your health care expenses. While your insurance claims are being completed and filed, errors might crop up. Such errors committed by humans or computers, ought to get mentioned in the Explanation of Benefits that you receive.

The mistakes can be things like being billed for unutilized services, double billing, wrong amount, date mismatch, and so on. It could also be things like not being covered for a service that’s entitled to coverage, deductible errors, etc.

The Explanation of Benefits informs you how much you owe. It helps you in keeping track of medical services and the associated expenses. In case your EOB contains any errors, never hesitate to report that anomaly to both your health care provider and your health insurance company. Updating your information and ensuring you have the documents in place will come handy on a rainy day. Afterall medical expenses are mostly unplanned. The last thing you want to do is run around filing claims when you fall sick. We hope you found answers to all your EOB questions.