What Are the Components of an EOB?

Most often used in the health care industry, interpreting and understanding your Explanation of Benefits statement can be a difficult process. They often include information on multiple cases and insurance claims with a number of internal codes that need to be deciphered. However difficult as they may be to read, they contain crucial information regarding your health care benefits. Recognizing the components of an EOB and knowing what to look for can save you time and potential frustration.

Contact and Declaration Information

• Both the patient and service provider contact information is prominently displayed on an EOB. The contact information generally includes the address and phone number of each party. If you have received an EOB, you may also find an ID number that references you and your case. These are internal designations used to identify your information. Most EOBs also include a notice stating, "This is not a bill," or something similar. If monies are owed, a separate bill will be mailed asking for remittance. The EOB is for informational purposes only.

Providers and Dates

• If a visit to a doctor, dentist or hospital included seeing more than one specialist, your EOB will include each of those service providers on separate line items. It is when there are multiple providers shown that the explanation of benefits can appear a bit overwhelming. Each separate line is specific to a provider, so reviewing them one by one should provide you with the appropriate information. These items also include the dates service was received. This allows you to match the dates and providers with your own records to ensure accuracy.

Code Numbers

• A sometimes difficult aspect of interpreting EOBs is the code numbers used for several purposes, depending on the company providing the EOB. Code numbers are used to explain why particular benefits were denied, to request additional information or to give other insurance data if applicable. The backs of EOB statements usually include references for each of the codes used. These can help you decipher these numbers and gain a better understanding of your explanation of benefits.

Amounts

• The dollar amounts are also included in your EOB. These include the amounts you may be responsible for after all other payments and adjustments are made. The amounts also include how much the insurance company paid (or intends to pay) to the providers for services rendered. Additional amounts you are likely to see on an EOB are what the provider charged for her services, as well as a breakdown of any deductibles and co-payments you may still owe in addition to uncovered fees.