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Home arrow Resources arrow Articles arrow What is an Explanation of Benefits?

What is an Explanation of Benefits?

As an insured individual, it is important for you to keep up with your records after any type of doctor visit or medical treatment. One way to do this is to look closely at your Explanation of Benefits (EOB) form, which is issued by your insurance company. The EOB form will provide you with everything you need to know in order to be sure you are not overpaying medical bills for your doctor's appointments, medical tests or surgical procedures.


What is an EOB?

The EOB form is a detailed statement produced and released by a health insurance company. It states the various medical treatment and services that are paid on the covered individual's behalf. The EOB form outlines all treatments, procedures or services performed including the date and insurer's code, where the services were performed, the name of the patient, and the medical providers who provided services. It also includes a variety of information about fees charged and paid, including the patient's balance due.

Why is an EOB Used?

The EOB is beneficial to all parties involved including the doctor's office, insurance company and patient. It ensures that all information provided is correct and accurate, including the types of treatments or services performed, fees paid and charged by the doctor or insurance company and how much of the balance is due by the patient. It acts as a record of medical treatments and fees charged to the insurance company. It also ensures that the medical coder or bookkeeper made no errors when calculating how much to charge the insurance company, and how much the patient is then responsible for.

As a patient, it is imperative that you look over your EOB closely each time you receive it and compare it to any other records you might have regarding your medical procedures or treatments, receipts from copays or other charges and any other important information.

Another important benefit of the EOB form is for your own records – so you may go back and see what types of medical procedures or treatment you had in previous years.

Information Included in an EOB

For starters, basic information will be included in the EOB form: Patient's name and personal information, such as a phone number, street address or insurance card number. It will also include a claim number that was submitted to the insurance company by either the healthcare provider or the patient and information about the healthcare provider such as the doctor's office or treatment center and doctor information that performed the procedure.

The type and date of service or treatment performed will also be detailed on the EOB form in as brief a description as possible and may possibly include a code for this type of procedure. The date and time of the treatment or service will also be included, as well as a detailed list of charges. Not only will the billed charges, like the amount the healthcare provider billed the insurance company for the medical treatment or procedure be listed on the form, but also the amount which was not covered by the insurance company.

The EOB will also show the balance the patient is responsible for paying to the healthcare provider. The total patient cost may be one of the most detailed sections of the EOB form as it states the remaining balance of the medical bill, as well as any out-of-pocket expenses like copayments, deductibles or co-insurance payments.

In summary, once you receive your EOB, the first thing you should do as a patient is to go over every section of the form and be sure all of the information is accurate. This includes the patient and doctor information, insurance company information, services, labs or treatments performed, the date and time of your medical visit or procedures and any costs charged to the insurance company or to you as the patient. Doing so ensures that all of the information is accurate and that you are not being overcharged for medical procedures.

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