Read your EOB before you pay your medical bill

Ways in which your EOB can be helpful

It's proven that the best way to get costs under control is to get employees engaged, informed, and empowered to make the best choices for their needs and their budgets.

First, you have to read it

While you might be tempted just to toss your EOB, 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 hesitant 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 what 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.

A closer look at your EOB

The EOB lists basic personal information, including your name, address, and ID number, as well as ways to contact your insurance company. It will vary from insurer to insurer, but your EOB likely includes a summary of your claims as well as more detailed claims information, such as:

• Your doctor or hospital standard charge
  
  
• The portion your plan doesn't cover ("excluded amount")
  
  
• The discount – the amount you save by using an in-network provider
  
  
• The "allowed amount"
  
  
• Amount after your deductible, copayment, and coinsurance is substracted, if applicable
  
  
• Benefit amount, the amount your insurer considers for payment
  
  

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

• Other insurance carrier paid – the amount paid by other insurance, if you have coverage in addition to your primary health 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.

Additional sections on the EOB

There may be one or more sections that recap the information listed above and include 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 should also include 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 read the code descriptions.


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.

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.

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