An explanation of benefits (EOB) is a statement you receive from your health plan or insurance company after a medical procedure or office visit that explains what portion of the medical bill was covered by your insurance and what you still need to pay. Though this document can be complicated, it’s important to understand what it says so you can pay your medical bills accurately and fix any billing errors that may happen to occur.

 

Service Dates

The Service Dates section (2) indicates the date(s) your medical procedure occurred.

Description of Service

The Description of Service section (3) lists the procedure that was completed on the service date.

Billed

The Billed section (4) shows the amount the provider billed before any negotiated adjustments, co-pays, deductibles, or any ineligible amount is accounted for.

Allowed

The Allowed section (5) shows the amount of the Billed section that is allowed under the provider contract This is sometimes called the network discount.

Provider Discount

The Provider Discount (6) is the billed amount minus the allowed amount.

Not Covered

Under the Not Covered section (7) is any amount determined to be ineligible for payment by your health plan.

Reason Code

The Reason Code (8) is used to explain the reason for an adjustment or benefit limitation. You can also find an Explanation of Codes toward the bottom.

Deductible

Under Deductible (9) you will find the portion of the allowed amount (if any) that will be applied to your annual medical deductible. This will be added to the co-insurance and co-pay amounts to determine your member responsibility.

Coinsurance

Under Coinsurance (10) you will find the portion of the allowed amount (if any) that you will be responsible for as part of your health plan co-insurance.

Co-pay

Under Co-pay (11) you will find the portion of the allowed amount (if any) that you will be responsible for as part of your health plan co-pay.

Payment

Under Payment (12) you will find any amount you paid to the provider at the time of service.

Other Insurance Credits or Adjustments

This section (13) will show any amount paid by another health plan or insurance company for the procedure.

Total Payment Amount

Under Total Payment Amount (14) you will find to total of the payments paid to the provider at the time of service.

Member Responsibility

The Member Responsibility (15) is the total amount you owe including any co-payments, deductibles, co-insurance, and/or excluded charges.

Explanation of Codes

The Explanation of Codes (17) section is used to explain the reason something isn’t covered or is discounted from the billed amount.

 

Who to contact with questions

The customer service box in the top right corner (1) gives you all the contact information for your health plan provider so you can contact them should any questions arise.

If you are on the Helpside Medical Plan, you can view your Explanation of Benefits (EOB) online or on the EMI Health mobile app. Knowing how to navigate your benefits is important. Reach out to Helpside at service@helpside.com if you need any help.