How to Read and Explanation of Benefits (EOB)

Reading an Explanation of Benefits (EOB) can be tricky. It almost seems like they are specially formatted to be confusing.

However, reading EOBs is definitely a skill worth learning. After all, knowing how to do it right will result in less stress for you while quickly enabling you to be sure that the reimbursements you’re getting from insurance are accurate.

So, we thought it was worth diving into this topic a little deeper. Let’s go!

First things first, an explanation of benefits (EOB) is a document that explains, in detail, how an insurance company processed a claim for medical services you rendered.

An EOB can be a helpful tool for understanding how the claims you are submitting for reimbursement are being processed, along with what the allowed amounts are from insurance!

Here are the key things to look for on an EOB:

Provider information: This includes the name of the doctor, hospital, or other health care provider who provided you with services.
Dates of service: This shows when you rendered the medical services.
Codes: This section lists the medical codes (CPT) for the services you rendered. These codes are used by your health insurance company to determine the amount of your benefit.
Charges: This shows the amount that was billed out for the services rendered..
Allowed amount: This is the amount that the health insurance company will pay for those services, regardless of network status.
Paid amount: This is the amount that your health insurance company has paid you for the specific services rendered.
Amount owed by a patient / Copay / Deductible / Coinsurance: This is the amount that the patient owes for the services rendered, after their insurance company has paid their portion. If you are out of network, that portion may include more due to not having contractual obligations.

Here are some additional things to keep in mind when reading an EOB:

The EOB is not a bill: The EOB is not a bill. It is simply a document that explains how a health insurance company processed your claim.
The EOB may not be accurate: The EOB may not be 100% accurate. If you believe that there is an error on your EOB, you should contact the health insurance company to have it corrected through the use of resubmissions, corrected claims or appeals.
The EOB can help you understand your patients health insurance coverage: The EOB can be a helpful tool for understanding your patients health insurance coverage. By carefully reviewing your EOB, you can learn more about what services are covered by their plan and how much your patient will owe for those services.

Here are some tips for reading an EOB:

Take your time: Don't rush through reading your EOB. Take your time to carefully review all of the information.
Ask questions: If you don't understand something on your EOB, don't be afraid to ask questions. Some EOB’s are rather confusing and have ‘fees’ taken out of them (such as American Speciality Health or Zelis). Contact the health insurance company for clarification.
Keep your EOBs: Keep your EOBs for future reference. They can be helpful if you, or your patient, has any questions about their health insurance coverage or if you need to reference a past insurance claim.

For any further questions about EOBs or anything else billing related, we can help you and your business succeed. If you are ready to pass on the tasks of billing or are feeling like you are not getting the money you deserve for services provided, check us out at www.bushidobilling.com and we will provide you solutions to saving time and money.

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How to Read and Explanation of Benefits (EOB)

Here are the key things to look for on an EOB:

Here are some additional things to keep in mind when reading an EOB:

Here are some tips for reading an EOB:

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