What is an EOB?

 

An EOB, or Explanation of Benefits, is a report from the insurance payor with their decision on the insurance claim. It contains important information such as the procedure billed and the amount paid. You will typically receive this 30-45 days after submitting a claim.

Different insurance payors’ EOBs may look different from others. However, the general information is consistent.

EOBs are very important. The information is relevant to what you want to accomplish as a medical biller – collecting payment for services billed.

However, before we start, it is important to remember that the EOB is not a bill. Instead, it is only an explanation of the results of the decision from the insurance company.

What Does An EOB Contain?

Patient Information

An EOB usually contains patient and insurance company information. This includes, for example:

  • Patient’s name, date of birth, & address
  • Subscriber ID (their insurance enrolment ID)
  • Insurance company name & address
  • Customer service number, etc.

Claim Information

The next part of the EOB contains the claim information. For example:

  • Date of service/procedure code/type of service – tells you when the procedure was performed and the code for the procedure billed. Each procedure is listed in an individual row.
  • Amount Billed – total cost for a specific procedure.
  • Discount – if the patient’s insurance plan is “in-network” with the healthcare provider, then a charge may be discounted. The amount of the discount depends on the insurance plan/contract.
  • Amount Covered – the total amount that could be covered by the insurance plan, after the discount.
  • Amount Not Covered – the remainder not paid for by the insurance plan

Some other information on the EOB may include the deductible, copay amount, and coinsurance. These numbers vary based on the patient’s insurance plan and are amounts that the patient is responsible for paying.

 

Curious about what deductibles are or what out-of-network providers means? Check out our other post with common medical billing terms. 

Questions About Insurance Payments?

If you have any further questions as to why a claim was not paid, you can call the customer service number on EOBs. Just make sure you have the EOB on hand to answer any identity verification questions the insurer may have (i.e. subscriber ID, Date of Birth, etc.). Asking questions and getting a full understanding behind the payment of your claims can also help if you decide to appeal unpaid claims.

Finally, each EOB may look slightly difference depending on the insurance company it was issued by. However, the important information all remains the same. Insurance companies sometimes also have sample EOBs on their websites so you can get familiarized with them.

By understanding what information goes on an Explanation of Benefits, it makes it easier to go through them and decide what to do next.

Americare Network

With so many different Explanation of Benefits, it is important to keep everything organized and ensure appeals and payments are made in a timely manner. If it becomes too much to handle, you can contact Americare Network to hear how we can help you with the process, saving you time and costs. Our team of experts ensures billing is done quickly and effectively, keeping track of claims and appeals as needed. Looking forward to hearing from you!