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A Simple Explanation: Understanding EOBs

You know the drill: Shortly after receiving healthcare services, you get mail from your insurance provider. The good news? As it says in big letters, “This is not a bill.” Unfortunately, that makes it tempting to ignore. But don’t–this Explanation of Benefits (or “EOB”) is important.

As you look at your EOB, keep a few things in mind:

  • Different EOBs for different things: You might get multiple EOBs for a single visit to a healthcare provider. That’s OK. They cover different aspects of your visit.
  • Names: The “insured” has the insurance coverage; the “claimant” is the person who received medical services.
  • Charges: Different insurers use different words to describe charges, but one way or another, the EOB tells you:
    • The original charge
    • A reduced amount your insurer has negotiated
    • The amount your insurance covers
    • The amount you pay
  • Codes: These footnotes explain factors that went into charges.
  • Deductible/Out-of-Pocket to Date: This lets you know how much more you have to spend before you meet your deductible or out-of-pocket limits.

An EOB can look intimidating, but it’s pretty clear once you get used to looking at it. It’s important that you do look at it to confirm you’re being charged correctly. If you have questions about information on your EOB, contact your insurer immediately. There’s usually a limit to how long you can wait before questioning a cost.

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