September 4, 2024

Demystify your EOB

According to PwC, 60 percent of full-time employees are stressed about their finances. Helping your employees understand how their benefits package fits into their financial needs can have a significant impact on their health and wellbeing.

An Explanation of Benefits or EOB can be a powerful tool for managing medical expenses. But have you or one of your employees ever received an EOB from your insurance company and thought, “What even is this?” You’re not alone. An EOB can look intimidating at first glance, but spoiler alert: it's not a bill! In fact, it’s your crystal ball, giving you a heads-up about any upcoming medical bills. In this article and corresponding podcast episode, we'll break down the mystery of the EOB, walking you through the key information it contains, how to read it, and what it means for your wallet.

What Exactly is an EOB and Why Should You and Your Employees Care?

An Explanation of Benefits (EOB) is a document sent by your health insurance company after you receive medical services. It's a detailed statement that outlines the costs of the services provided, what your insurance covers, and what you might owe. Understanding an EOB is crucial because it helps you:

• Verify that the services you received were correctly billed.
• Ensure that your insurance plan is paying what it should.
• Identify any billing errors or discrepancies.
• Get a preview of your upcoming medical bills.

The Must-Know Parts of an EOB

Reading an EOB can be overwhelming, but knowing what to look for can make it much easier. Here are the key sections to focus on:

1. Patient Information: This section includes your name, the patient’s name (if different), and other identifying information.
2. Provider Information: The name of the health care provider or facility where you received medical treatment.
3. Date of Service: The date when the service was provided.
4. Service Description: A brief description of the medical service or procedure performed.
5. Charges: The total amount billed by the provider for the service.
6. Allowed Amount: The amount your health plan considers reasonable for the service.
7. Insurance Payment: The portion of the allowed amount that your insurance company pays.
8. Patient Responsibility: What you owe, including deductibles, copayments, and coinsurance.
9. Remarks or Notes: Any additional information or explanations about the claim.

How to Use Your EOB to Anticipate Bills and Avoid Surprises

Your EOB is a powerful tool for managing medical expenses. Here’s how to use it to your advantage:

• Compare with Bills: When you receive a bill from your health care provider, compare it with your EOB to ensure accuracy. The amounts should match what your EOB indicates as your responsibility.
• Check for Errors: Look for any discrepancies or errors in the charges, services listed, or amounts. If you spot something wrong, contact your insurance company or provider for clarification or correction.
• Understand Your Costs: Use the EOB to understand how much you’ll need to pay out of pocket. This can help you budget for medical expenses and avoid surprise bills.
• Track Your Deductible: Your EOB can show you how much of your deductible you’ve met. Keeping track of this can help you predict future costs and know when your health insurance will start covering more of your expenses.

For More Hands-On Learning, Check Out These Sample EOBs

To help you become an EOB-reading pro, we've provided a couple of sample EOBs for you to review:

• Sample EOB 1
• Sample EOB 2

These samples can give you a practical understanding of what to expect and how to interpret the details on your own EOB.

Join Us for a Bite-Sized Dive into the World of Health Insurance Paperwork

In our latest episode of our “Under the Coverage,” podcast we take a quick, fun, and enlightening dive into the world of EOBs. By the end of the episode, you'll be ready to tackle your health insurance mail with confidence.

Hit play and demystify your EOB today! 💌🔍

🎧 Listen now and subscribe

Empower yourself and your employees with knowledge in every episode and take control of your health care journey.

#Healthcare #Insurance #EOB #UnderTheCoverage