Reasons to review your Explanation of Benefits (EOB)

While you might be tempted just to toss it, here are a few reasons why you should give it a closer look:

• It's not a bill - Unlike most of your mail, the EOB doesn't require you to make any kind of payment, so you don't have to be afraid to open it.
  
  
• It can keep you from paying money you don't owe - If you take a close look at your EOB before you look at your medical bills, you can save yourself the hassle and expense of paying when you don't owe!
  
  For example, your doctor may send you a bill for all of the charges. However, you may only owe a small portion of that bill. You won't know that unless you review the EOB or wait for the provider's adjusted bill — which may not come right away.
  
  
• It's not that complicated - OK, so it does have a lot of little boxes and grids. Relax. It's much easier than an IRS form! Each box is clearly labeled, and it's easy to follow — once you understand the information shown.
  
  

A closer look at your EOB

The top section of the EOB lists basic personal information, including your name, address, and Humana ID number. It also gives the address and phone number of the Humana office to contact if you have questions.

The bottom section is divided into two parts — Claim Summary and Claim Detail information — that show you how Humana processed your claim:

Claim Summary

• The first item listed is the provider's standard charge.
• From the charge, Humana subtracts the excluded amount — the portion your plan doesn't cover.
• We also take out the provider discount, the amount you save by using an in-network provider.
• This leaves the allowed amount.
• We subtract your deductible, copayment, and coinsurance, if applicable.
• This leaves the benefit amount, the amount Humana considers for payment.

To show you exactly who's paying what to whom, the summary also lists:

• Other insurance carrier paid — the amount paid by other insurance, if you have coverage in addition to your Humana plan.
• Estimated member responsibility — the estimated amount you owe, which may differ from the amount the provider billed you. If it does, call the provider and discuss it. Never pay from a provider's statement without checking your EOB.
• Amount paid by Humana — Shows how much Humana paid for this claim.

Claim Detail

This section is a recap of the information listed above and includes a breakdown of the charges — information that's especially helpful if you've been in the hospital and received a number of services or procedures.

The Claim Detail also includes dates of service, a service code for each charge, and remark codes — so if you don't know what a charge is for or need an explanation, just turn the EOB over and read the code descriptions. You'll find other helpful details on the back of the EOB, too, like your preventive care benefits, unused benefits, and the amount you've paid toward your deductible.

Of course, if you disagree with any of the payment amounts, you have the right to appeal. With every EOB, you receive information about the appeals process.

Skip the paper completely

Of course, if you'd rather not keep up with a stack of paper EOBs, there's a simpler way to get the same information online. You'll find all claims details at MyHumana, your personal, password-protected home page on www.humana.com.

Just look for the "MyCommunications" section. Click on the link "Change MyCommunications Preferences" and check the box to receive electronic EOBs. You get the same information, and it's online anytime you need it.

If you haven't registered for MyHumana, it just takes a couple of minutes. Go to www.humana.com and click on "Register Now" in the upper right-hand corner of the home page.

Bottom line:

Your EOB is like a detailed record of your healthcare spending. Not only can it help you keep track of the services you and your family receive, but it can also keep you from paying more than your share of the costs.