Every time a health care provider submits a claim for services, your insurer reviews it and sends you an explanation of benefits (EOB) after your medical visit. It may seem like just paperwork, but before you toss it in a pile or ignore it, take a closer look.

Your EOB is much more than routine mail; it’s a valuable tool that:

• Empowers you to make informed decisions about your health care.
• Helps you avoid unnecessary costs and catch billing errors.
• Supports financial planning and budgeting for medical expenses.
• Keeps you aware of your benefits and coverage limits.

What is an explanation of benefits?

An EOB is a statement from your health insurance plan that details the coverage of medical care or products you received, and the out-of-pocket costs you may owe. The EOB is not a bill; if you owe any out-of-pocket costs, they will be billed to you by your care provider.

What details does an EOB include?

Your EOB is designed to be clear and easy to read. While layouts may vary by insurer, most EOBs include:

• Provider information: The name of the doctor, hospital, or pharmacy that provided care.
• Services billed: A list of medical services or products received, with dates and codes.
• Amount billed: The total cost submitted by the provider.
• Discounts or adjustments: Any negotiated discounts or reductions applied by your health plan.
• Amount paid by insurance: What your health plan covered.
• Your responsibility: The amount you may owe, such as deductibles, copays, or coinsurance.
• Reason for non-coverage (if applicable): If a service was not covered, the EOB will explain why.
• Appeal rights: Instructions for requesting a review or appeal if you disagree with a coverage decision.
• Glossary: Definitions of key terms to help you understand the document.

How to read your EOB

Start with the summary page. This snapshot shows the amount billed, discounts, what your plan paid, and your out-of-pocket responsibility. Next, review the detailed breakdown of services. Compare these details with any bills you receive from your provider – sometimes there are discrepancies, and your EOB can help you spot them.

Tips for reading your EOB:

• Check the provider and service dates.
• Review the codes and descriptions.
• Compare costs.
• Look for denials or adjustments.
• Track your deductible and out-of-pocket maximums.

What to look for – and why it matters

Your EOB can help you:

• Make sense of your costs: Your EOB breaks down how costs are shared between you and your health plan. It shows exactly what was billed, what was covered, and what you’re responsible for.
• Take control of your expenses: By tracking your EOBs, you can monitor your health care spending, see how close you are to meeting your deductible, and plan for future expenses.
• Identify potential errors: Mistakes can happen – wrong billing codes, duplicate charges, or services you didn’t receive. Your EOB is your first line of defense.
• Keep track of benefits: Your EOB helps you stay informed about your coverage, including what services are covered, how much you’ve spent, and what benefits remain.

What to do if you have questions

If your EOB doesn’t match your provider’s bill, or if you don’t understand a charge, reach out to your insurer using the contact information on the EOB. Many insurers also offer online resources, videos, and customer service support to help you understand your benefits.

Final thoughts

Your explanation of benefits is more than just paperwork – it’s a key to understanding your health care coverage and costs. By taking a few minutes to review each EOB you receive, you can protect yourself from errors, manage your expenses, and make the most of your benefits.