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Explanation of an EOB

You'll typically see the words “This is not a bill" when you view an explanation of benefits. While that statement might cause a sigh of relief, it doesn’t explain why you’re receiving the health care summary. Health care providers send the summary to provide a detailed break down of the health care services you received and the cost.

  1. EOB Basics

    • Although every health insurer designs its own EOB, all typically provide the same information. The front of the EOB might resemble a bill, but it includes the name of the insurer, along with your name, address and policy number. The EOB provides the date or dates of service. If the services were provided for dependents, the EOB includes their names and relationship to you. The front of the sheet also might include the health insurance company’s information such as telephone number and hours of operation.

    Services and Charges

    • The EOB outlines the type of health care received and any services performed. Each service is listed separately. The summary provides the cost of each service. The EOB might have a box titled “Your Provider Charged.” The cost includes the price your physician charges before any discounts. If the insurer and physician negotiated a discount, the EOB lists the percentage in a separate box.

    Payments

    • The EOB summarizes payments sent to the health care provider. For example, the boxes titled co-payments, deductible and out-of-pocket summary include any payments you’ve made or must make toward the health care services. Typically, a health insurer lists the payments it makes according to your insurance plan. The box titled “Amount We Paid Your Provider” provides the amount the company paid to your doctor. The EOB includes spaces for the health insurer to list payments from other health insurance companies or Medicare. If you don’t have any additional health insurance, those boxes remain blank.

    Considerations

    • Whenever you visit a health care professional, the doctor’s offices submits the information to your insurance company to receive payment. The health insurance company processes the claim and reimburses the health care professional on your behalf. The health insurer then sends you an EOB describing what it paid. The EOB also includes how much you might owe after the company has paid the claim. The health care professional, though, sends you a bill if the health insurance company doesn’t cover the entire cost of services. The EOB includes information on how to file an appeal of a denial of benefits and the time you have to file.

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