What’s an Explanation of Benefits (EOB)
Explanation of Benefits, or EOB, is a type of summary you receive from your health insurance company after you have received your medical service. It is to visually show what you are totally charged for your visit, how much of it was covered by your insurance, if any discounts are applied, and what you owe back to the company.
Importantly, an EOB is not just a piece of bill, it’s a detailed breakdown of the cost of care being used between your provider, insurance and you.
The EOB supports to understand:
● What services you get
● What your providers is charging you
● What amount your insurance paid
● Any amount applied to your deductible or copay
● What you may be responsible for paying out-of-pocket
Review of your EOB makes sure you’re only charged for what you owe and can help catch any billing errors early.
But What Does It Actually Contain?
The Explanation of Benefits states general information about you and your health plans such as:
● You (the patient)
● Your health plan
● Who is providing care, and when are they providing
● Reference number that is known as claim number
● The person who gets reimbursed for any overpayments, called the payee
Your EOB helps to give you a clear picture of what your plan covered and helps you know what to expect when your provider sends a bill.
Details Regarding Your Claim(s)
The Explanation of Benefits provides you a step by step breakdown of your care, including:
● The date you received service – When were you given the treatment or service.
● A description of service – a detailed explanation of whatever the service was taken, like medical visits, lan test, x-rays, procedures or any preventive screening. This is used to confirm that the services mentioned match what you actually review.
This detailed information makes it easier and quicker to track your care, understand applied charges, and point out any errors.
Information Regarding Your Bill
The explanation of benefits lists the cost of your care, and how much your health insurance company will pay.
The key terms mean:
● Provider Charges – This is the total amount your healthcare provider is charged for your visit or services, before any adjustments to accounts.
● Allowed Charges – This is the amount your insurance company has agreed for paying for the received services, based upon what’s your plans coverage and provider contacts. It’s often lower than the Provider Charges.
● Paid by Insurer – This is the portion of the Allowed Charges that your insurance company has to directly pay to your provider.
The EOB also shows if you owe anything, such as a copay, deductible, or coinsurance. Reviewing this section helps you understand how your benefits were applied and what to expect when you get a bill from your provider.
What You Owe?
What You Owe, or Patients Balance, is the amount of money you owe after your insurance company has paid everything else.
You may have already submitted the payment part of the Patients Balance. Thus the Explanation of Benefits showing what you owe, not if you’ve already paid for it.
Your bill is not supposed to be higher than the Patient Balance. If it is, talk to your provider.
Remark code
A note from the health plan containing additional information about the fees, charges, and amounts paid for your visit is called a remark code.
The code is usually 2 or 3 letters and numbers long. Check the bottom of the explanation of benefits for a description of each code.
