Understanding Your Explanation of Benefits (EOB)

Every time you receive care from a provider or file a claim for services received, your insurer will send you an “Explanation of Benefits.” This form is not a bill. It explains what medical treatments and/or services were provided and the amount the insurance company will pay towards any covered charge.

It is important to take note of the following information on your EOB:

  1. Verify that the name of the patient and provider seen is accurate
  2. Verify date for the service performed
  3. Review the procedure code and brief description of the service performed
  4. Review the billed amount as well as the allowed amount for the service</l
  5. Review the amount the insurance paid as well as the amount the patient is responsible for paying within plan structure
  6. Review instructions related to appeal rights including important timelines for appeal submissions

The information presented within the EOB should make it easy to match bills from providers and ensure accuracy.

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