Understanding Explanation of Benefits (EOB)

Dr. Eric Bricker explains the Explanation of Benefits (EOB) in health insurance. He details how EOBs are generated every time a claim is filed and highlights the key components to review, such as the date of service, billed amount, insurance discounts, and the amount owed. He advises comparing EOBs with medical bills to ensure accuracy and provides guidance on resolving discrepancies by contacting the insurance company or healthcare provider.

What is an Explanation of Benefits (EOB)?

• A document detailing your insurance policy terms

• A bill from your healthcare provider

• A statement from your insurance company about a claim

• A summary of your medical history

How can you receive your EOB?

• Only through the mail

• Through the mail, app, or insurance website

• Only by visiting the insurance office

• Only through the insurance app

What should you verify first on an EOB?

• The doctor's name

• The insurance discount

• The date of service

• The amount you owe

What does the insurance discount or denial section indicate?

• The total amount billed

• The name of the service provider

• The amount you owe

• Whether the insurance company applied a discount

What happens if the insurance company does not apply a discount?

• You pay the full billed amount

• The insurance company pays the full amount

• You receive a refund

• The bill is canceled

Why might the amount paid by the insurance company be zero?

• The deductible has not been met

• The service was free

• The insurance policy was canceled

• The claim was filed incorrectly

What should you do if the amount you owe is more than expected?

• Ignore the EOB

• Throw away the EOB

• Compare it with the bill from the provider

• Pay the amount immediately

If the EOB and the bill from the provider show different amounts owed, who should you contact first?

• The government

• The bank

• The healthcare provider

• The insurance company

What is the purpose of comparing the EOB with the bill from the provider?

• To ensure the amounts match

• To find errors in the EOB

• To calculate the total insurance coverage

• To verify the provider's credentials

What is the next step if the EOB and bill amounts match but you still have concerns?

• Contact the healthcare provider

• Contact the insurance company

• Ignore the concern

• Pay the bill immediately