KNOW ALL ABOUT EOBS AND ITS BENEFITS

EOB is commonly referred to as an Explanation of Benefits. It provides complete information about the payments for a medical service that a person has received. It explains what portion of the medical claims needs to be paid by the active medical insurance plan and what portion of the medical claim needs to be paid by the patient. A Patient often receives an EOB through mail or in their email when their health care provider submits a medical claim on behalf of them. However, a person must understand every line of EOB when they are reading it to check whether they or their insurance company is billed for the right service.

Role of EOB in medical billing:

After providing the healthcare services, the healthcare provider will bill the medical expenses to the insurance company. Later the patient may also receive a separate bill regarding the medical expenses not covered by the insurance company. This medical statement will also include instructions on whom to be paid directly- either the health insurance company or the health care provider.

EOBs are a tool to explain the value of the health insurance plan. With it, a patient can notice the cost of their services and the savings they had with their active insurance plan. For some insurance companies, EOBs also helps a person to meet their annual deductible. Once the patients clear their deductible, their insurance plan begins to pay for the services they will receive in the future.

EOB is not a medical bill:

EOB closely resembles a medical bill however it is not a bill.  It tells a person how much their healthcare provider has charged them. EOBs act as a reference for the medical bills only. The medical bills will come separately and will be sent by the service provider to the insurance company. However, some healthcare service providers need-up front payment, in that case, the patient will be reimbursed by the insurance company. If the medical insurance company does not cover any specified medical service or any other medical expense including copay and deductible then that expense should be directly paid and billed by the provider to the patient.

Information that an EOB includes:

• The date on which a patient has received the service
• The amount that has been already paid by the insurance plan
• Patient’s claim number, health insurance ID, or policy number
• The name of a doctor, dentist, or any type of healthcare provider
• Name of the patient, or the name of a dependent who has received the service
• Procedure codes of the availed service and types of equipment used during the process
• The charges of the service that the healthcare provider has billed to the insurance company, The remaining amount that is the patient’s responsibility

Benefits of EOB include:

• An EOB tells a person how much they owe. The amount a person owes should match the amount that is listed to them. 
• Many policyholders have now access to their medical accounts online, so they can digitally access their EOBs. It will help them to check their EOBs without waiting for the mail to arrive in the mailbox.
• The EOB helps a person to find the errors in their medical bills such as if they have been billed for the services they have not received or billed twice for the same lab tests. Other errors include incorrect dates of service, or the healthcare provider has billed a wrong amount for the service and many more.
• EOBS is the best medium that helps a person to understand how their insurance plan works. So, one should make sure that they get an explanation of benefits when they visit their doctor, to check what services they have received and what services are not covered by their insurance plan.
• An EOB also helps a person to track their medical care and costs. A list of EOBs includes all the medical services and equipment they have received during the whole year with their costs. Therefore one should keep their EOBs safely so that they have a record of what they have received and how much they have charged for it.
• An EOB can save a patient from overpaying medical bills charged for the services they availed. Before paying bills, a person needs to check an EOB in the mail and compare it with the amount mentioned in the patient’s statement to ensure that they are paying the right amount to the healthcare provider. If one found any error in their bill from their healthcare service provider’s side then they can call their insurance company to let them know about the error.