Jeffrey Wade
An insurance bill is a complex document that outlines the costs associated with medical services received. It can be challenging to decipher, with various codes, jargon, and adjustments that may not be immediately clear to the average person. The bill will include details such as the date of service, the type of care received, and a breakdown of charges. It is important to review insurance bills carefully to identify any discrepancies or errors and to ensure that the charges align with the services received. Understanding insurance bills can be made easier by seeking explanations from doctors' offices and insurance companies, as well as comparing the bill to any prior estimates provided.
| Characteristics | Values |
|---|---|
| Format | May vary by insurance company |
| Personal details | Name, member number, plan information |
| Visit information | Date(s) of service, doctor or clinic's name, type of care received (e.g., preventive care or office visit) |
| Charges | Breakdown of charges for service(s) received, showing how much the insurance company paid and the amount the patient owes |
| Amount owed | "Amount you owe" or similar wording |
| Tear-off portion and return envelope | May not be included |
What You'll Learn
What is an Explanation of Benefits (EOB)?
An Explanation of Benefits (EOB) is a statement from your health insurance company that details the costs of the medical care or products you've received. It is not a bill, but it will explain any charges that you still owe or may have already paid, such as a copay at the time of receiving medical care.
The EOB is generated when your provider submits a claim for the services you received. It will include information about who provided your care, when it was provided, and a reference number called the claim number. It will also list your health plan's phone number, which you can call if you have questions about finding a provider or what services they cover.
The EOB will show the total charges for your visit, including the amount your provider bills for your visit ("Provider Charges"), the amount your provider will be paid ("Allowed Charges"), and the amount your health plan will pay to your provider ("Paid by Insurer"). It will also show the amount you owe, or the "Patient Balance", which is the amount you are responsible for after your insurer has paid.
The EOB can be a useful tool for understanding how your bill is broken down between the medical service provider(s), your insurance, and you. It can also help ensure that you are receiving the full benefit or discount that you are entitled to under your insurance plan.
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How to read an EOB
An Explanation of Benefits (EOB) is a statement sent by your insurance company that details the costs of the healthcare services you received. It is not a bill. If you owe money, you will receive a separate bill from your healthcare provider.
An EOB includes multiple sections, providing details for your claims, including the name of the provider who performed the service, the date, type of procedure, and the costs. Here is a breakdown of the different sections:
Provider
The name of the doctor or specialist who provided the service.
Service/Procedure
The type of service you received, such as a medical visit, lab tests, screenings, or surgery.
Total Cost
The amount charged for the service.
Not Covered
The amount of the service not covered by insurance (this usually only occurs if the service is denied).
Deductible
If there is a deductible for the service, you would need to pay this amount before the insurance company pays their share.
Copay/Coinsurance
The amount you pay.
Other Patient Responsibility
Any other costs you may need to pay for the service (this usually only occurs if the service is denied).
Plan's Share
The amount the insurance company pays for the service.
Total Your Share
The total amount you pay for this service. Again, the EOB is not a bill, and you may have already paid the total amount shown.
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What to do if your EOB and bill don't match
If your Explanation of Benefits (EOB) and bill don't match, there are a few things you can do to rectify the situation. Firstly, it's important to understand that an EOB is not a bill. It is a document sent by your insurance company outlining what they will pay for a doctor's visit, hospital stay, or other medical expenses. Billing mistakes are common, so it's crucial to review your EOB and bill carefully. Here are the steps you can take if you notice a discrepancy:
- Collect all the paperwork: Gather all the relevant documents, including your EOB and bill. Sometimes, multiple EOBs can apply to a single bill, especially if you received multiple types of services or treatments during the same visit or on different days.
- Compare codes and descriptions of services: Cross-reference the codes and descriptions of services on your EOB with those on your medical bill. Ensure they match and look out for duplicate charges.
- Review the services received: Check that the services listed on the bill are accurate and match the services you actually received. Verify that the amount you owe aligns with your health insurance benefits.
- Check personal information: Confirm that your name and policy number are correct on both the EOB and the bill. This step is important to ensure you are not accidentally billed for someone else's healthcare services.
- Contact your healthcare provider: Reach out to your healthcare provider's office or the business department of the hospital/medical facility. Ask them to review the bill with you and ensure it includes only the services ordered and received. If there is an error, inquire about the process to correct the billing.
- Request an itemized bill: Obtain an itemized bill from your healthcare provider or facility. This bill will provide a detailed breakdown of each charge, allowing you to compare it with your EOB to identify any discrepancies or errors.
- Contact your insurance company: Get in touch with your health insurance company to discuss the differences between the bill and the EOB. They can provide clarification and guide you through the process of resolving any issues.
- Keep a record of communications: Make sure to take notes during your conversations with both the healthcare provider and the insurance company. Note the names of the people you speak with, the dates of your conversations, and any actions that need to be taken. Follow up if you don't receive a corrected bill or if there was an error identified.
By following these steps, you can help ensure that you are not overcharged and that any billing discrepancies are resolved. Remember, understanding your insurance coverage can be complex, but it's important to review your EOBs carefully to protect yourself from billing errors or fraud.
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What if you don't get an EOB?
If you don't receive an EOB, there are a few possible reasons. Firstly, if you are a member of a health plan and your doctor's office has your insurance information, they will usually submit the insurance claim for you. However, if they don't have this capability or you visit an out-of-network provider, you may need to submit the claim yourself. In this case, you may receive a bill from your healthcare provider before you get an EOB.
Additionally, there are situations where you may not receive an EOB at all. For instance, many health plans don't send an EOB if the member doesn't need to pay anything.
In any case, it is recommended that you don't pay your clinic or hospital bill until you receive an EOB for that service. This ensures that you don't pay more than you owe. If you have any questions or concerns, you can always contact your insurance company for assistance.
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How long should you keep your EOB?
An Explanation of Benefits (EOB) is not a bill, but it is an important document that details the medical procedures or treatments you have undergone, the charges for these services, and how much your insurance company has paid. It is recommended that you keep your EOBs for a certain period, but how long depends on your individual circumstances.
If you are claiming a refund on your taxes, the IRS advises keeping EOBs and other tax documents for three years from the filing date of your original return or two years from when you paid your taxes, whichever is later. If you didn't report income that you should have, hold onto your documents for six years. If you are claiming the medical tax deduction, keep the EOBs for seven years.
Outside of the IRS guidelines, it is generally recommended to keep EOBs for three to eight years after receiving medical care. If you have a recurring condition, it is a good idea to keep your EOBs indefinitely for personal records.
If you are assisting someone with care, such as an elderly or chronically ill relative, you may want to keep their EOBs to have a record of their health history. In the case of a serious illness, keep EOBs for five years after the illness has been resolved or seven years if you've claimed a medical deduction.
To sum up, the length of time you should keep your EOBs depends on your personal situation and tax requirements. Be sure to store them securely and consider digitizing them for easy access and to prevent loss.
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Frequently asked questions
An insurance bill is a claim submitted by a doctor's office to an insurance company. It lists the services provided by the doctor to the patient.
An EOB is a report sent by an insurance company to the patient, explaining what the insurance plan will cover and what it won't. It is not a bill.
An EOB includes personal details like name, member number, and plan information, along with information about the doctor's visit, including the date of service, doctor's name, and type of care received. It also includes a breakdown of the charges for the services received.
An insurance bill will include an account number, service date, description of services, charges, billed charges, adjustments, insurance payments, patient payments, and the balance due.
If your EOB and bill don't match, there could be a prior balance for unpaid medical expenses, or your bill may include charges for more than one date of service. You should contact your doctor's office to see if your account has been updated with a payment from your insurance company.
