How to Find Your Explanation of Benefits
Navigate your Explanation of Benefits (EOB) to clearly understand your medical claims, insurance payments, and patient responsibility.
An Explanation of Benefits (EOB) is a statement from your health insurance company detailing how a medical claim was processed for services you received. It outlines the costs covered by your insurance plan and any amount you might be responsible for paying. An EOB is not a bill, but an informational summary of your healthcare costs.
Understanding Your Explanation of Benefits
It clarifies what your insurance plan paid and any remaining amount you may owe. An EOB includes details such as patient information, provider details, and the date of service. It also describes services received, often including medical billing codes like CPT codes, explained in simple terms. You will see the total charges billed by the healthcare provider, the amount your insurance paid, and how much was applied to your deductible, copayment, or coinsurance. The EOB states your patient responsibility, which is the amount you may owe the healthcare provider.
Locating Your Explanation of Benefits
Accessing your Explanation of Benefits can be done through several common methods. Many health insurance companies offer secure online member portals where you can view, download, and print your EOBs digitally by logging into your insurance provider’s website, often navigating to a “Claims” or “EOB” section. EOBs are also frequently sent via postal mail to your home address. Check your mail regularly after receiving medical services. If you are unable to locate an EOB through online portals or mail, contact your insurance company’s customer service department by phone or secure message to request a copy.
Interpreting Your Explanation of Benefits
Understanding the financial terms on your EOB is important. The “billed amount” is the initial charge from your healthcare provider, while the “allowed amount” is the maximum sum your insurance plan will pay for a covered service. Your “deductible” is the amount you must pay for covered healthcare services each year before your insurance begins to cover costs. A “copayment” (copay) is a fixed amount you pay for specific services, such as a doctor’s visit or prescription. “Coinsurance” represents a percentage of the allowed amount that you are responsible for paying after your deductible has been met, and the “patient responsibility” section indicates the total amount you are expected to pay out-of-pocket, which includes any applied deductibles, copayments, or coinsurance.
Next Steps After Review
Once you have located and understood your Explanation of Benefits, take further action. Compare the EOB with the actual bill you receive from your healthcare provider. This comparison helps identify discrepancies in services, dates, or billed amounts. Should you find any errors or have questions, contact the healthcare provider’s billing department first, or reach out to your insurance company for clarification. Maintain organized records of your EOBs is beneficial for tracking medical expenses or for future reference.