Understanding Your Explanation of Benefits (EOB)

If you received a medical bill that was partially covered by your health insurance, it's important to understand your Explanation of Benefits (EOB). The EOB outlines what your insurance policy covers and what expenses you are responsible for. Here’s how to interpret your EOB and clarify what was and wasn’t covered.

What is an Explanation of Benefits (EOB)?

An EOB is a document provided by your health insurance company that explains how a medical claim was processed. It includes details about the services provided, the amount billed by your healthcare provider, the amount covered by your insurance, and any remaining balance you owe.

Key Sections of an EOB

• Patient Information: Identifies the patient and the insured individual.
• Service Details: Describes the medical services or treatments received, including dates and provider information.
• Amount Billed: Shows the total amount billed by your healthcare provider for the services rendered.
• Allowed Amount: Indicates the amount your insurance company considers reasonable for the services provided, based on your policy and network agreements.
• Insurance Payment: Displays the amount your insurance company paid to the healthcare provider.
• Patient Responsibility: Lists the portion of the bill you are responsible for, which may include deductibles, copayments, and coinsurance.
• Reason Codes: Provides explanations for any adjustments or denials, often using standardized codes.

Understanding What Was and Wasn’t Covered

To clarify what was and wasn’t covered by your insurance, review the following sections of your EOB:

• Covered Services: These are the services for which your insurance company has made a payment. The EOB will show the amount covered and any patient responsibility for these services.
• Non-Covered Services: These are services that were not covered by your insurance policy. The EOB will indicate why these services were not covered, using reason codes.
• Adjustments: These are amounts that were adjusted or reduced from the billed charges based on your insurance company’s agreements with healthcare providers.

Common Reasons for Non-Covered Services

Services may not be covered for several reasons, including:

• The service is not covered under your policy.
• The provider is out of network.
• The service was deemed not medically necessary.
• The service exceeded policy limits.

Need Further Assistance?

If you have questions about your EOB or need further clarification on what was and wasn’t covered, please contact our customer service team at [Customer Service Phone Number]. We are here to help you understand your benefits and resolve any issues.

Thank you for choosing [Insurance Company Name]. We are committed to providing you with the best possible service and support.