Understanding Your EOB

Most EOBs list the provider, the date of service and each service billed. Next to each service you will usually see the amount billed, the allowed amount your plan agreed to pay for that service, the amount the plan paid and your responsibility. Your share may be listed as deductible, copay or coinsurance. Remark codes or notes explain why an amount was reduced or denied, and a key is usually printed on the statement or available online. If a term or code does not make sense, call the member services number on the EOB and ask them to walk you through it.

When a bill arrives from a hospital or doctor, find the EOB for the same date and service. The amount the provider asks you to pay should generally match the patient responsibility on the EOB. If the bill is higher, the provider may have billed before insurance finished processing or may have made an error, so call their billing office before paying. File EOBs by date or by provider so you can find them quickly. Keeping them together also shows how close you are to your deductible and out-of-pocket maximum, which helps with planning.

Scan every EOB for denied services, care you do not recognize or dates that do not match your appointments. Many denials come from simple issues such as a coding mistake, a missing referral or a provider listed as out of network by error. Call your insurer to ask what is needed to fix the problem, then ask the provider to correct and resubmit the claim if needed. If the denial stands, the EOB or a separate letter should explain how to appeal and the deadline for doing so. Unfamiliar charges can also signal medical identity theft, so report them promptly.

1. 1

   Open every EOB and check the provider, date and services against your appointment calendar.

2. 2

   Match each provider bill to its EOB before paying anything.

3. 3

   Call your insurer about any denial, remark code or charge you do not recognize.

4. 4

   File EOBs by date or provider and track totals toward your out-of-pocket maximum.