Understanding Your Explanation of Benefits (EOB): A Comprehensive Guide
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March 28, 2025 | Tags:
To help you get the most from your benefit coverage while keeping costs affordable, it is important that you understand your coverage and use your benefits according to your benefit plan or certificate of coverage.
Reviewing your Explanation of Benefits (EOB) will help you better understand your benefits.
What is an EOB?
An EOB helps to give an overall picture of your healthcare service costs. Details about your claim and what services you received will be included.
While it's easy to confuse them with a bill, it's important to note that an EOB is not one. In fact, you will typically see the phrase "this is not a bill" on them. Your provider is responsible for sending you an invoice directly.
EOBS help to prepare for whatever costs are still owed and will be billed, so understanding how to read one is vital.
Why EOBs are important
EOBs are important for a few reasons:
- They help members get a full picture of their overall healthcare costs. A bill is not always as detailed and may not show the extent of what's already been covered. An EOB helps provide a precise explanation of how your claim is broken down.
- It allows for another way to check to see if what is being charged is accurate. When you understand what should be covered, you're better prepared to spot any discrepancies.
Another benefit to having an EOB is for tax documentation purposes as well as when it comes to planning for larger medical services such as surgery or an MRI. With an EOB, you get a better sense of where you are at in meeting your deductible and can plan accordingly.
Key components of an EOB
As mentioned, the EOB will provide a detailed overview of what services you received:
- Basic information, like policyholder name, benefits provider name, and ID number.
- As summary of your claim, which is the amount paid your health plan and what you owe. Expect to see details of the claim, like the name of the patient, a list of services billed, and the explanation of your final responsibility for the services covered. You'll be able to see the breakdown of costs in an easy-to-understand list.
- An update on your deductible and coinsurance balance.
How to read your EOB
Think of your EOB as a behind the scenes look of your overall care. At first glance, the amount of information may seem overwhelming, but it's more digestible once you know what to look for.
Since the EOB is broken into sections, try reading through it one piece at a time. Your explanation of final responsibility, for example, has several components:
- Type and/or date of service.
- Amount billed.
- Allowed amount.
- Benefits paid.
- The amount you are responsible for along with the totals of each.
While most members will likely be focused on the amount owed, it's also good to see exactly what your benefits are covering so you can spot any inconsistencies. By also including your deductible and coinsurance balances, EOBs help you keep track of what you still need to pay. This can help both individuals and families better prepare for larger costs.
Tips for managing EOBs
Depending on the number of services you have will determine how many EOBs you receive. Choose electronic delivery to save paper and keep your EOBs in on convenient location.
Medical Mutual knows how important it is to have transparency when it comes to your healthcare, so we've made it easier to access your EOB. Our EOB emails now link directly to the service or procedure in the My Health Plan portal.
Still have questions about your EOB? Medical Mutual is here to help. Call the Customer Care phone number listed on your member ID card to speak with a representative.