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Reading your Explanation of Benefits (EOB)

  • What is an EOB?

    An Explanation of Benefits (EOB) is a summary of charges submitted to your insurance plan detailing the amounts you and your insurance plan will/have paid. An EOB is NOT a BILL, it is a tool to help you understand your insurance coverage. You may get a bill separately from the service provider. 

  • What does an EOB look like?

    An EOB can vary depending on your insurance plan, however, the information contained will remain relatively the same. Below is an example of an EOB.

     

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    What does this information mean?

    We have labeled some important elements to help you understand.

    1. Service Date - the date the service or equipment was provided. Rental products bill on the day provided and on the same day of each subsequent month. 
    2. Procedure Code - any product or service billed to a health plan has a registered procedure code. Procedure codes tell your insurance plan what kind of product or service has been provided. 
    3. Modifiers - provide clarification of the product/service, such as whether an item is a purchase or rental. 
    4. Billed Amount* - the amount a provider is billing for its product or service. 
    5. Allowed Amount - the amount a provider is contracted to receive as payment for its product or service. This amount may not be the same as Billed Amount. 
    6. Deductible - the amount deemed patient responsibility to satisfy a deductible.
    7. Coinsurance - the amount deemed patient responsibility to satisfy coinsurance. This amount is similar to the copay paid during a Doctor's Office visit. 
    8. Paid by Health Plan - the amount paid by the insurance plan .
    9. Total Patient Responsibility - the total amount owed by the patient for coinsurance, deductible and non-covered products/services. 
    10. Remarks - a note from the insurance plan that explains more about the costs, charges, and paid amounts for the service or product.

    *The Billed Amount is typically only relevant when a provider is out-of-network and does not have a contracted rate with your insurance plan. 

  • What if I have secondary insurance?

    If you have primary and secondary insurance plans, you may receive two EOBs (one for each plan). The EOB from your primary insurance plan will indicate if any amounts that would have been your responsibility have been forwarded to your secondary insurance plan. 

    Coverage by secondary insurance plans vary, but commonly do NOT cover amounts deemed your responsibility to satisfy a deductible.

  • Have questions?

    If you have questions about your Explanation of Benefits or why certain amounts were deemed your responsibility, you should contact your insurance plan.