What is an explanation of benefits?
An explanation of benefits (EOB) is an insurance company’s statement that describes the costs involved for visits to your doctor or clinic. In short, it’s a statement to let you know a claim has been filed, along with details of the costs.
An EOB is different from a bill. Its purpose is to tell you which costs your insurance has paid for and what you, the patient, must pay. Your medical provider will send a separate bill for your amount, which should match what’s on your EOB.
How do you read an EOB?
Even though there might be a lot of information and terminology, an EOB doesn’t have to be overwhelming. Once you get familiar with the terms and layout, your EOB can be a handy way to track your health expenses and coverage.
An EOB typically includes:
- Your name
- Your plan information, including name and member ID
- The doctor, health professional or facility that provided services
- A claim number and status
- The service(s) description and date it was provided
- Total cost of service(s)
- How much was paid by your health insurance plan
- Costs your health plan didn’t cover
- Any amount that might have been paid from an HRA
- What you owe
- Additional information, such as a glossary of medical terms, how to find your EOB online, and where to call with questions
- Some EOBs also show out-of-pocket expenses that count toward your deductible
Why is an EOB important?
An EOB is a tool that can help you better understand how your insurance works. This can help you feel confident in making decisions about your plan and care.
EOBs can be useful to track your health care costs, find billing errors, understand what your plan covers and for tax documentation. Over time, you may start to see patterns that can help you decide if your insurance plan is right for your needs.
What if I find an error on my EOB?
If you find a mismatch between your EOB and the bill from your provider, first double check a few possibilities:
- A previous balance was carried over
- A payment was made between the time the EOB and bill were sent. This means the EOB doesn't show the real costs.
- The bill was sent to you before your insurance company paid. In this case, you could wait for your company to process the claim and send you an updated bill.
Sometimes, seeing an out-of-network provider is out of your control. For example, emergency care or an out-of-network provider is involved in your care without your choice. In this case, the federal No Surprises Act or state surprise billing law may protect you from paying more than your copayment, coinsurance or deductible.
Once you’ve checked on those common errors, call your doctor or clinic to see if there’s an explanation and request an itemized bill. Then, call your insurance company to ask about the error. If needed, you might ask about filing an appeal. Be sure to save a file of your EOBs, medical bill and details of your calls.
How long should I keep my EOB?
Since EOBs can provide both short- and long-term value, it’s a good idea to save your EOB at least until you get the final bill from your doctor or clinic. It might be useful to keep paper copies for future reference — especially if you’re facing a chronic illness or serious condition.
Understanding your EOB is a big step toward feeling empowered when it comes to your health insurance. Regularly reviewing your EOBs can help you stay an active participant in your health care and potentially avoid wasting money due to errors.
Questions? If you’re a UnitedHealthcare member, sign in to your member account or use the UnitedHealthcare app to see your claims.