If you have ever received an Explanation of Benefits (EOB) in the mail and tossed it aside because it looked confusing, you are not alone. But your EOB is one of the most important documents in your healthcare journey, and understanding it can save you real money.
An EOB is not a bill. It is a statement from your insurance company that shows what was billed by your provider, what the insurance company paid, and what you may owe. You will receive a separate bill from your provider for any balance due.
The key sections to look at are: the service date (does it match your visit?), the billed amount (the full charge from your provider), the allowed amount (what your insurance considers reasonable), the plan payment (what insurance actually paid), and your responsibility (your copay, coinsurance, or deductible amount).
Common errors to watch for include: being charged for services you did not receive, duplicate charges for the same service, being billed at out-of-network rates when you saw an in-network provider, and incorrect procedure codes that lead to denials.
If you spot an error, contact your insurance company first using the phone number on your EOB. Keep a record of every call. If the issue is not resolved, contact your provider's billing department. For persistent issues, a patient advocate can help you navigate the dispute process.
We review EOBs and medical bills for our clients every day at Marin Healthcare Navigation. If something does not look right on yours, reach out for a free review.