Explanation of Benefits – Why Is it Important? 

Medical bills can be confusing even for those with top-notch health insurance from a trusted carrier. That’s why, after a visit to a health care facility and submitting a claim against your coverage, your health insurance company will generally send you an explanation of benefits (EOB) form. These documents are intended to help you and your fellow policyholders understand what was or wasn’t covered during a visit with a health care provider. However, while EOBs can provide valuable insight and information, they can also be complicated and difficult to understand.

At 314 Insurance Advisors, our team is committed to helping you and your family understand and optimize your health insurance coverage. With this goal in mind, we are happy to provide guidance on EOBs.

What Is Included in an EOB?

After accessing your health coverage for medical services, you will typically receive an EOB to help you understand the details of your visit as it pertains to your insurance. Although the exact makeup of these documents may vary among insurance companies, EOBs often include the following information:

• Name and address of the policyholder
• Name of the patient
• Group number
• Member ID number
• Claim number
• Date of the claim being processed
• Date of services
• Name of the health care facility
• Name of the health care provider
• Description of services or procedures
• Billing code
• Amount billed to the insurer
• Amount of the bill eligible for coverage
• Reasons for noncoverage
• Amount of the bill subject to the policyholder’s deductible

• Amount paid by the insurance company

Why Are EOBs Important?

Overall, the primary purpose of an EOB is to help you and your family understand whether your claim has been paid and how much you may owe. With this knowledge, you can better understand which invoices are your responsibility and how much to expect in total out-of-pocket costs, such as to reach your deductible and for copayments and coinsurance. Given the many line items that may make up your medical bills, requesting itemized invoices to help you compare costs and coverage amounts with your EOB is essential.

Wrapping Up

EOBs can provide critical information for you and your family as you attempt to decipher what you may still owe following your insurance company’s contributions. These documents can also help you investigate potential errors, such as whether your policy should have covered more toward an appointment or procedure.

Contact the dedicated team at 314 Insurance Advisors to learn more about health insurance and EOBs. Visit our website or call 502-265-0906 to get started today.

This blog is intended for informational and educational use only. It is not exhaustive and should not be construed as legal advice. Please contact your insurance professional for further information.