Explanation of Benefits: What is it?

Explanation of Benefits: What is it?
Photo by Arisa Chattasa / Unsplash

Amethyst Storey

An explanation of benefits – or "EOB" – can help you understand several important aspects of your health care costs. It is important to read your EOBs as they arrive.

The EOB tells you how much you owe. It is not a bill, which you will receive separately from your provider. The amount you owe that is listed on your bill should match the amount you owe listed on your EOB. If you have not received your bill or have not paid your provider yet, the EOB can help you make smart financial decisions.

The EOB helps track medical care and costs, as well. Your EOBs list all the medical services and equipment you received throughout the year and how much they cost. The only exception to this is medical service that is not billed to your insurance company. Keep your EOBs so that you’ll have a record of what care you received, how much you were charged for that care, and what your health plan covered of those charges.

The EOB helps you find errors. When health insurance claims are completed and filed, errors are sometimes made by humans or computers, and these might be reflected on your EOB. Here are some of the mistakes you might find:

  • Being billed for services you did not receive.
  • Double billing, such as being billed twice for lab tests.
  • The provider billed the wrong amount for a service.
  • Your insurance company did not cover a service they should have, according to your plan.
  • Incorrect dates of service
  • An error with your deductible

The EOB helps identify potential medical fraud, as well. If your EOB lists services you did not receive, it’s possible your provider is billing fraudulently. This might point to medical identity theft or insurance fraud.

Errors on your EOB that are not corrected could lead to long-term financial difficulties.

If your EOB contains any kind of mistake, or if you suspect that it does, you should call your health insurance company, your health care provider, or both. Don’t be shy about going over every line with each of these offices. Your financial and medical well-being are worth the effort.

Below is an infographic that helps explain the information that should be on every EOB:

Image courtsey of Amethyst VA Solutions.