How to Read an EOB

You know the drill: Shortly after you’ve been to the doctor, lab, hospital, or other healthcare providers, you get mail from your insurance company. The good news? As it says in big letters, “This is not a bill.” Unfortunately, that makes it tempting to ignore it. But don’t – this Explanation of Benefits (or “EOB”) is important. As you look at your EOB, keep a few things in mind:

Each EOB will correlate to a specific bill or bills. You should be able to match individual EOBs to specific bills. Unfortunately, that’s sometimes hard to do. Key things to look for when matching bills to EOBs are “claimant” (the person who received the service), service dates, and amounts charged. Once you line those up, you can usually make the right match.

But wait … sometimes there’s a catch. You might receive the EOB before you receive the corresponding bill, because providers often wait until the insurance company reviews the bill before sending it to you. Other times, you’ll receive a bill before it goes to the insurer. If you have health coverage and a claim was submitted to your insurer, don’t pay the bill until you get the corresponding EOB.

You might get multiple EOBs for a single visit. If your visit involved more than one provider or service, you’ll likely get an EOB for each one. For example, a trip to the hospital might result in one EOB for the facility, one for the caregiver who attended to you, another for a lab that ran tests, and so forth. That’s OK.

You need to check the details. If mistakes are made on a claim, it often shows up on the EOB. Make sure basic things such as the name of the insured and the name of the “claimant” (the one who received services) are correct, as well as things like your address and plan ID number.

Know your numbers. Different insurers use different words to describe what you’re being charged for, 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

Check the footnotes. These will explain factors that affected your charges and costs.

Watch your deductible and 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. And 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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