Interpret an EOB
An explanation of benefits (EOB) is written notification from your insurance provider that you have had at least one claim filed and paid on your behalf. The insurance company processes the claim from your doctor or hospital, a check is sent and the claim is marked as complete. Shortly after, you will likely receive a bill from your doctor with the amount you owe, if any. Around the same time, you should also receive your EOB so you can compare the totals given by your doctor and the insurance company.
Instructions
1. Verify the services shown on the EOB were actually performed for the patient listed. Your EOB will likely list the services by date with a brief explanation of each. It will also list the medical provider who performed the service and/or the hospital where it was performed. If you do not recognize the name of the doctor, hospital or service, you may have to research further for an answer.
2. Note the amounts paid on the claim by your insurance provider. The EOB will list the total billed charges, any network discount and the total paid. If you see the insurance company did not pay anything on a claim, there is usually a reason code listed so you will know why the service wasn't covered.
3. Confirm the amount you are responsible for paying to your health care provider. The EOB will show you how much you owe for services performed. Make sure the amount you were billed from your doctor's office matches up to the amount the insurance company says you are responsible for paying.
4. Ensure your deductible and out-of-pocket amounts have been applied correctly. Before your insurance will pay claims for you, you may have to meet a deductible amount. The very first money you pay toward a medical service will first go to pay that deductible amount. Once you have met the deductible, your insurance picks up and begins to pay according to your plan particulars, and you begin to pay toward an out-of-pocket maximum. Each EOB updates your deductible and out-of-pocket amounts, so you can verify what you have paid with the amount your insurance has applied.
Tags: your insurance, from your, insurance company, your doctor, from your doctor, deductible amount, deductible out-of-pocket
