How to Read an Explanation of Benefits

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Every once in a while, you’ll get an Explanation of Benefits (or, “EOB”) from your health insurer. What is it? What is it trying to tell you? Is it a bill?

No, it’s not a bill, but it does have useful information on it. Let’s look at an example of an EOB, so you can see what all the pieces mean: 

What Your EOB Says
What It Means for You
Service Performed By: Dr. Human Person
Service: Annual Physical
Date of Service: March 5, 2020
Place of Service: Main Street Health
This just provides the who, what, when and where of medical services that you received (in this case, your annual physical).
Charge: $150
Discount: $50
Charge After Discount: $100
Here, the EOB lays out how much the doctor charged for your physical, minus any discounts your insurer and doctor may have agreed to.
Insurance Pays: $90
This tells you how much of the amount charged has been paid by your insurer.
Amount Remaining: $10
If there’s any amount left over, it will be listed here. You could be billed by your doctor for this amount, but that bill will come from them, separate from your EOB.
You have paid $850 of your $1,000 deductible for 2020.

You have paid $850 of your $8,000 out-of-pocket maximum for 2020.
Here, your insurer gives you a running tally of how much you’ve paid toward your deductible and out-of-pocket maximum for the year.

So, the EOB says the doctor’s office charged $150 for your annual checkup, discounted $50, and that your insurance plan paid for $90 of the remaining $100 bill. Now, there’s only $10 left to be paid (but you don’t need to pay it until your doctor’s office sends you a bill). 

You’ll often get an EOB sometime after you see a doctor or dentist, go to the hospital or get other health care services. The EOB will go over what services you received and how your health insurer helped pay for them.

You can find details about what your health insurance plan pays for in your plan’s handbook or Evidence of Coverage (EOC).

And remember that your EOB contains protected health information (PHI) that belongs to you. That is, it goes into details about your personal medical history, details you might want to stay personal. So, keep your EOB safe.

Read Your EOBs

Don’t be afraid of your EOBs, read them. They help you know whether you should pay any bill you receive.

Contact Us With Questions

If you do have any questions about an EOB we’ve sent, or anything else about your Virginia Premier plan, just contact us.

You may also be interested in reading: What is Health Insurance and Why It It Important.

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