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What’s an EOB?

You have insurance, had a doctor’s visit, received an EOB, now what?

Knowing how to read your EOB or Explanation of Benefits, is helpful to understanding your medical coverage and may keep your gray hairs at bay. Essentially your EOB is a statement from your health insurance plan which breaks down in complete description the costs they will cover for care and or products you’ve received. This explanation is created and delivered once your provider submits a claim regarding the services you’ve received.

Your EOB Is NOT a Bill

There’s no need to panic! Your insurance provider sends you an EOB to help make clear:

  • Cost of care you received
  • Amount of money you saved by visiting an in-work provider
  • Out-of-pocket medical expenses you will be responsible for

How to Read Your EOB

Please note, EOBs are not bills. They are simply a recorded statement of the medical services you’ve received and details on how your provider plans to share costs. You do not use this to pay an outstanding bill. Your bill can be broken down into a summarization of:

  • Your details and personal information
  • The medical services received and by who
  • Amount billed: The cost of those services
  • Discounts: Money you saved by accessing care from in-network providers
  • Amount covered and paid by your insurance
  • Amount not covered: What costs your health plan didn’t cover
  • Amount that was paid by HRA (if applicable)
  • The outstanding amount you are responsible for paying

Following this information is usually information regarding instructions on how to make an appeal, and then finally, there are more in-depth details about your total cost of care received.

The Purpose of an EOB

When you receive health care, your insurance provider will send you an EOB with the previously stated information. After this is received, you may receive a separate bill for the actual amount you owe. Information on this separate piece of paper will let you know where you can send your payment. Essentially EOBs are helpful because they provide you the value of your health insurance plan and can help you to gauge how much money you potentially have left in accounts related to your health insurance plan. These are also helpful for those who are wondering how close they are to meeting their deductible. That’s all the better because once your deductible is met, your provider will begin to help you pay for services received!

If you need help understanding this information or feel like you’re in need of a different type of coverage, contact me today at 361-652-3005 and we can get started on providing you with the care and coverage you actually need.