An explanation of benefits (EOB) statement can help break down the various components. If you learn how to read this important document, you'll be able to understand why you owe the charges. An explanation of benefits statement is sent to you after a health insurance claim.
What is an explanation of benefits?
An explanation of benefits is a document that explains how your insurance processed the claim for the services you received. It breaks down the information like this:
Should I Save my Explanation of benefits forms?
You should always save your Explanation of Benefits forms until you get the final bill from your doctor or health care provider. Compare the amount you owe on the EOB to the amount on the bill. If they match, that's the amount you'll need to pay.
Can I get an explanation of benefits from my doctor?
If you are a member of a network or your doctor's office has your insurance information, most likely they can submit the insurance claim for you. But if they don't have that capability, you may have to submit the claim yourself. In that case, you may get a bill from your doctor or health care provider before you get an Explanation of Benefits.
How to read a health insurance explanation of benefits statement?
When reading a health insurance explanation of benefits statement, take the time to inspect each entry on this page. Make sure the numbers match up with the stated figures on page one. It’s also good practice to compare your EOB with any subsequent bills you receive to ensure you are not overpaying for services rendered.
Should you keep your explanation of benefits?
Comparing your EOBs to your monthly statements is a good way to understand what you are being charged for, and it gives you another opportunity to look for overcharges. Unlike medical bills, EOBs should be kept from three to eight years after your procedure, or indefinitely if you have a reoccurring condition.
Why is it important to check the explanation of benefits?
EOBs are a tool for showing you the value of your health insurance plan. You see the cost of the services you received and the savings your plan helped you achieve. EOBs also help you gauge how much money you may have left in accounts related to your plan.
How long should you keep explanations of benefits?
When you or someone you are caring for is seriously ill, it is recommended that you keep EOBs for five years after the illness or condition is alleviated. If you or the patient is claiming or has claimed a medical deduction, keep the explanation of benefits for seven years.
How does a patient read an EOB?
1:342:35How to Read Your Medical EOB - YouTubeYouTubeStart of suggested clipEnd of suggested clipThe amount you pay for the service this is the amount that you will be billed. Remember the EOB isMoreThe amount you pay for the service this is the amount that you will be billed. Remember the EOB is not a bill it just shows you how the costs are distributed. If you have any questions by your EOB.
What is allowed amount on EOB?
The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”
Is an explanation of benefits a legal document?
Everyone that posts dental insurance checks knows what an EOB is and how important that document is for explaining if and how the claim was paid and if the patient still owes any money on the claim.
What do you need to keep for 7 years?
Keep records for 7 years if you file a claim for a loss from worthless securities or bad debt deduction. Keep records for 6 years if you do not report income that you should report, and it is more than 25% of the gross income shown on your return.
What important documents do I need to keep?
Important papers to save forever include:Birth certificates.Social Security cards.Marriage certificates.Adoption papers.Death certificates.Passports.Wills and living wills.Powers of attorney.More items...•
How long should I keep prescription receipts?
All other medical records, however, such as premium statements, physician or hospital bills, copies of prescriptions, only need to be kept for five years after treatment has ended, unless you have claimed items on your tax returns, in which case the supporting documents should be kept for seven years.
What are the three figures that are commonly depicted on an EOB?
the payee, the payer and the patient.
What does EOB today mean?
end of businessIt's used in business communications to set a deadline for a task to be completed by 5:00 PM Eastern Standard Time (EST). COB can be used interchangeably with end of business (EOB), end of day (EOD), end of play (EOP), close of play (COP), and close of business (COB).
Do prescriptions show up on EOB?
Your prescription drug Explanation of Benefits (EOB) statement shows a summary of your past medication orders. It is not a bill. Express Scripts records your prescription claim on an EOB statement each time you get a prescription filled at a retail network pharmacy or through home delivery.
What is EOB in billing?
Around the time you receive your patient billing statement, you will also receive an explanation of benefits (EOB) from your insurance provider. An explanation of benefits is a document that explains how your insurance processed the claim for the services you received.
What is paid by insurance?
Paid by Insurance: Paid by insurance is the amount of the total charges that insurance is paying towards the claim. Patient responsibility: You may be responsible to pay an amount of the charges/service. This amount is based on your insurance benefits and what the facility and provider charge. The actual billing statement ...
What is deductible insurance?
Deductible: A deductible is the amount you pay for health care services before your insurance starts to pay anything. Copay: A copay is a fixed amount you pay for a health care service covered by your insurance. It is typically due before we provide service. Copays are different for different services in the same plan.
How to contact University of Utah Health?
If you would like to schedule an online, face-to-face visit, please make an appointment or call us at 801-587-6303.
Is a service covered by health insurance?
The service you had is not covered by the health insurance plan benefits (also called a non-covered benefit). Your insurance coverage was ended (terminated) before you received this service. You received the service before you were eligible for insurance coverage (not eligible for coverage). There may be instances when an insurance carrier denies ...
Do you pay a copay for emergency care?
You may pay a different copay for your primary care than for a specialty service. Emergency care copays are also higher than other copays amounts. Coinsurance: Based on your insurance benefit, coinsurance is the amount you may be required to pay towards the claim, apart from any copayments or deductible.
What happens when you receive an EOB?
A health care provider will bill your insurance company after you’ve received your care. Then you’ll receive an EOB. Later, you may receive a separate bill for the amount you may owe. This bill will include instructions on who to direct the payment to--either a health care provider or your health insurance company.
What is the EOB page 2?
Any outstanding amount you are responsible for paying. Page 2, contains a glossary of the terms and definitions included on your EOB, as well as instructions for how you can appeal a claim, if necessary. Page 3, provides more specific details about the cost of the care you received.
What is an EOB?
An EOB is a statement from your health insurance plan describing what costs it will cover for medical care or products you’ve received. The EOB is generated when your provider submits a claim for the services you received. The insurance company sends you EOBs to help make clear: The cost of the care you received.
What is page 3 of a medical deductable?
Depending on your health plan, page 3 may also reflect what portion of your out-of-pocket medical expenses count toward your annual deductible. Additional information, may include language assistance instructions, as well as more specific details about filing an appeal in your state of residence.
What does EOB mean for prescription drug?
When you receive an EOB from your prescription drug plan provider, they are providing you with a tool that shows you the value of your coverage with them. You can use it to keep an account of your annual deductible amount, to see whether you have reached it, or how much is left to go.
What to do if you find errors in Medicare?
If you find errors, or have questions, call your plan provider right away. If you believe that Medicare fraud is involved, call the Medicare Drug Integrity Contractor. The EOBs you receive provide monthly and annual summaries of your prescription drug plan costs.
Does Medicare have an EOB?
An Explanation of Benefits (EOB) is not a bill ...
What is an explanation of benefits statement?
An explanation of benefits statement is sent to you after a health insurance claim, to lay out the details of the service, the charges from the provider, the amount covered by insurance, and how much money is still due. Each time they provide services to you, doctors, dentists, and other medical professionals will submit claims to your insurance.
What is EOB insurance?
In turn, the insurance company will send you an EOB. This is to inform you of the claims submitted, how much is being covered by insurance, and how much you owe. 1.
What is an EOB statement?
Key Takeways. An EOB is a statement from your insurer. It outlines which portion of a claim it has paid and what portion you will have to pay. You should get an EOB any time your health care provider bills your insurance. Always take a close look at an EOB to be sure the charges are correct.
How does an EOB work?
How an Explanation of Benefits Works. An EOB can help you avoid paying more than you should for health care. Look over an EOB when it arrives in the mail ; then, compare it to your bills to ensure that you pay the correct amount. If you find an error on a bill from a doctor or other provider, call your insurance company to address the error.
What to do if you owe money to your insurance company?
If you owe money, ask the insurance company if this payment will be put toward your out-of-pocket deductible. Or, you may need clarification on charges for certain services, you can ask the provider to explain the services and charges for each.
What is a summary of your account?
A summary of your account with important identifying information and claim number. The details of the claim, including the date and specific services provided. The accounting, which includes the price of the service, the amount that your insurance is covering, and the difference between the two ...
Can you get more than one EOB?
Keep in mind that often you will get more than one EOB if you received more than one type of service or treatment, or if you received treatment on more than one day. You may have a stack of several, which you should save.
Can you be sure your insurance company paid your portion?
That way you can be sure your insurance company paid their portion and you're not paying more than you owe. Of course, if you ever have questions about a bill or an Explanation of Benefits, you can always call Member Services at your insurance company for answers.
Do you have to pay for the explanation of benefits?
The Explanation of Benefits is not a bill so, no , you shouldn't pay anything yet. It's really just a report of what your insurance plan is going to cover, based on what the doctor has charged and what type of plan you have.
What is a Coordination of Benefits?
An Employee Benefits plan is centered around receiving health services, as well as paying and adjudicating claims. When you use a service that is part of your health plan (massage, chiropractic, etc.), you’ll need to submit a claim to be reimbursed for the amount that you are covered for.
What is an Explanation of Benefits?
An explanation of benefits (EOB) is a statement that includes details about a medical insurance claim that explains what portion was paid to the health provider and how much the employee is responsible to pay out-of-pocket. This is generated and sent once it has been fully adjudicated or processed.
Final Thoughts
Hopefully, you now have a better understanding of how EOBs and COBs work, so the next time you submit a claim you'll know the process making it easier for you with faster reimbursement .
About Simply Benefits
Simply Benefits is a Third Party Payor (TPP) that provides Employee Health Benefits 100% digitally through our Canadian Advisor partners.
What Is An Explanation of Benefits?
- An EOB is a statement from your health insurance plan describing what costs it will cover for medical care or products you’ve received. The EOB is generated when your provider submits a claim for the services you received. The insurance company sends you EOBs to help make clear: 1. The cost of the care you received 2. Any money you saved by visitin...
Is My Explanation of Benefits A Bill?
- No. It is simply a statement of the medical services you received and details on how you and your plan will share costs. You will not use this to pay any outstanding bill.
How to Read An EOB
- Remember that EOBs state the costs associated with your care, but they are not bills. These documents are fairly standard among insurance companies. Here is a description of what each page of an EOB contains: Page 1 summarizes the following: 1. Your patient details 2. The medical services you received and from who 3. Amount billed: Cost of those services 4. Discounts: Any …
How Do EOBs Work?
- A health care provider will bill your insurance company after you’ve received your care. Then you’ll receive an EOB. Later, you may receive a separate bill for the amount you may owe. This bill will include instructions on who to direct the payment to--either a health care provider or your health insurance company. EOBs are a tool for showing you the value of your health insurance plan. Yo…