When your health insurance denies a claim, it's extremely frustrating. You may not know what you can do. I tell people to first take a look at their Explanation of Benefits (EOB).
What is an EOB?
An EOB is not a bill. Instead, it’s a summary from your insurance company showing how a medical claim was processed. It details what was billed, what your insurance covered, and what you might owe your healthcare provider.
Key Parts of an EOB
Every insurance company’s EOB format is a bit different, but most include the following sections:
- Patient Information: Confirms the EOB is for you or a covered family member.
- Provider Information: Lists the doctor or facility that provided the service.
- Date of Service: When the care was provided.
- Service Description: What treatment or procedure was performed.
- Amount Billed: What the provider charged.
- Allowed Amount: What your insurance considers a fair price for the service.
- Amount Paid by Insurance: What your insurance company paid toward the service.
- Your Responsibility: Any deductibles, co-pays, coinsurance, or non-covered services you may owe.
- Remark Codes or Notes: Explanations for why something was or wasn’t covered.
What to Do If Something Doesn’t Look Right
Errors on EOBs do happen—sometimes there are duplicate charges, services you didn’t receive, or payments that aren’t reflected correctly. Here’s what to do:
- Contact Your Provider: Call the doctor’s office or hospital billing department first if you think you’ve been billed in error.
- Call Your Insurance Company: The member services number on your EOB can connect you to someone who can explain the statement and help resolve discrepancies.
- Gather Documentation: Have your EOB, provider bill, and any other relevant paperwork handy when you call.
- Ask Questions: Don’t be afraid to ask for clarification on codes, charges, or denials.
- File an Appeal: If your claim was denied and you believe it should have been covered, ask your insurer how to file an appeal.
Final Tips
- Save your EOBs for your records, at least until all related bills are paid.
- Review each EOB as soon as you receive it—errors are easier to fix when caught early.
- Use your insurance company’s online portal for faster access and tracking.
Understanding your EOB empowers you to spot mistakes, avoid overpaying, and get the most from your health insurance coverage.
