how to read an explanation of benefitsUnderstanding an Explanation of Benefits (EOB) can be a daunting task, especially if you aren’t familiar with medical terminology or insurance jargon. However, it is essential to know how to read an EOB to make sure you are not being charged incorrectly and your insurance provider is covering your medical expenses as expected. Here’s a step-by-step guide on how to read an Explanation of Benefits.

Step 1: Understand the Layout
The first thing you need to do when reading an EOB is to familiarize yourself with the layout. EOBs can look different from one provider to another, but most EOBs will have the following sections:

  • Patient information: This section includes your name, date of birth, and policy number.
  • Service provider information: This section includes the name of the medical provider who rendered the services, the date of service, and the type of service performed.
  • Covered charges: This section includes the total amount charged by the service provider and the amount covered by your insurance.
  • Patient responsibility: This section includes the amount that you are responsible for paying, including co-payments, deductibles, and coinsurance.
  • Claim status: This section shows whether the claim was accepted or denied and the reason for the denial, if applicable.

Step 2: Check for Accuracy
After understanding the layout, the next step is to check for accuracy. Check to make sure the services listed match the services you received and the dates are correct. Make sure the amount charged by the service provider is accurate and matches what was agreed upon. If there are any errors, contact your insurance provider immediately.

Step 3: Look for Coverage Details
After checking for accuracy, look for coverage details. This section will show you what your insurance covers and what it does not cover. It will also show you the amount your insurance provider paid and the amount you are responsible for paying. If you see any services that are not covered, find out why and if there are any alternatives.

Step 4: Understand Your Patient Responsibility
The next section to look at is your patient responsibility. This section will show you the amount you owe after your insurance provider has paid its share. It will also show you any co-payments, deductibles, or coinsurance you need to pay. Make sure the amount is accurate, and if you have any questions, contact your insurance provider.

Step 5: Check the Claim Status
The final section to check is the claim status. This section will show you whether the claim was accepted or denied and the reason for the denial if applicable. If the claim was denied, find out why and if there is anything you can do to appeal the decision.

Reading an Explanation of Benefits can be challenging, but with a little understanding of the layout and a bit of patience, it is possible to understand your medical bills. Always check for accuracy, understand your coverage, and make sure that your patient responsibility is correct.

If you’re an IBT Consulting client and you have any questions or concerns about an EOB you’ve received, please don’t hesitate to contact us.