Understanding Your Explanation of Benefits

April 21, 2020 Off By Stephanie

If you have insurance, you’ve most likely received an explanation of benefits (EOB) in the mail after you’ve received medical care. Outside of noting the this-is-not-a-bill notation at the top of the statement, many people most likely disregard this piece of paper for lack of understanding and potential lack of care. However, examining your explanation of benefits is an important step in ensuring you are being charged according to your insurance plan, as well as help ensure the bills you receive in the future are accurate.

Incurring the Charges

Everything about your medical visit is tracked through the hospital’s chargemaster management program. Physicians use these programs to record the cost of your visit: procedures, supplies, drugs, tests, and services, along with any additional costs associated with equipment that was used. This populated list is then sent to insurance companies, who use the information to create an explanation of benefits.

Receiving the Explanation of Benefits

Once you receive the explanation of benefits, there are four main categories that can help explain what you will be charged and for what services:

1. Service description – description of the services you received.

2. Paid by the insurer – the amount the insurance company will pay to the provider on your behalf.

3. What you owe – the amount you owe, after insurance has paid their portion. This is what you should see on the actual bill from the hospital, once it arrives.

4. Remark – sometimes written as code, the remarks section will provide further information about the charges and what was or was not covered by insurance.

Once you understand the EOB, you can compare it with your insurance plan to make sure you are being charged correctly. The EOB statements can also help you track your deductible amounts so you know when you have reached your maximum out of pocket charges.

Learning to decipher an EOB may seem like learning a new language at first, but digging in just a little bit can help in a big way. Remember, your insurance company is there to help as well, so don’t be afraid to reach out and ask questions directly of them if you need to.