How an Explanation of Benefits HELP You | Senior Insurance Specialty Group

You have received an Explanation of Benefits (EOB), but what IS it, exactly?

An EOB is NOT a Bill

Let’s go ahead and clear this one up. An EOB is not a bill! An EOB is there specifically to help you understand the charges for any visits or prescription claims.

If It’s NOT a Bill, Why Do You Want It?

While an EOB is not a bill, It is an important document from your insurance provider that explains how your insurance processed the claim for the services you received. It also details how much your health plan covers on these services and what you should owe when you get a bill from your provider. Anyone enrolled in Medicare Advantage and Medicare Prescription Drug Plan (Part D) will receive an EOB the month after a claim.

What Information Your EOB will Include

Your EOB will include information about several things:

You as a patient
Your health plan
Who your provider was
Date care was provided
Description of service provided
A claim number (could be called a reference number)
Cost of care (provider charges)
Amount provider will be paid (allowed charges)
How much your health plan will pay your provider
What you owe after the insurer has paid
May show some (not all) of your copayment or coinsurance payments you have made
The person who will get reimbursed if there are overpayments

How to Use This Information

This detailed EOB can assist in helping you determine if the bills from your provider are correct.

One example may be the ambulance service. Often they do not obtain your insurance information. This could result in an expensive bill to you directly that could be paid, or partially paid, by your insurance. Seeing that your ambulance bill is NOT on your EOB is a red flag that you will need to contact them and give them your insurance information.

Other issues could include billing from diagnostics, hospital care, dental, and vision with the advantage plans. You always should be looking at your EOBs to verify that these bills are accurate and have gone through your insurance.

A Few More Things

If you have not received an EOB or have misplaced it, you should contact your insurance company as soon as possible. A representative will verify your mailing address or confirm if you have a paperless option chosen. If you have a paperless option, you may be able to view your EOB at any time.

Give Karen or Matt a call with any questions at 865-203-2040 or email us at contact@seniorinsurancespecialty.com!

*We do not offer every plan available in your area. Currently, we represent 11 organizations which offer 126 products in your area. You can contact Medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program for help with plan choices.