Explanation of Benefits Explained

Document being explained to people.

After you visit a provider, you may receive a document in the mail from your insurance carrier with an overview of the services provided. This isn’t a bill, but rather an EOB.

An Explanation of Benefits (EOB) is a statement from your insurance carrier that explains which services were provided, their cost, what portion of the claim was paid by the plan, and what portion is your liability, in addition to how you can appeal the insurer’s decision.

What does the EOB include?

  • Service descriptions of the healthcare services you received, such as lab tests or screenings
  • Provider charges: The total amount your provider bills
  • Allowed Charges: What your provider will be reimbursed
  • Paid by Insurer: The amount your insurance plan will pay to the provider
  • Payee: The person who will receive reimbursement if the claim is overpaid
  • What You Owe: The amount you or the patient owe after your insurance has paid

Make sure to keep any paperwork in case you need it later.

Content by Lockton Dunning Benefits with info from https://www.cms.gov/files/document/11819-sample-explanation-benefits-508.pdf