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.
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.
The Billed section (4) shows the amount the provider billed before any negotiated adjustments, co-pays, deductibles, or any ineligible amount is accounted for.
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.
The Provider Discount (6) is the billed amount minus the allowed amount.
Under the Not Covered section (7) is any amount determined to be ineligible for payment by your health plan.
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.
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.
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.
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.
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.
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 firstname.lastname@example.org if you need any help.