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What is an Explanation of Benefits (EOB)?

Health insurance explanation of benefits

If you are dealing with a work-related injury, an ongoing health issue, or simply your family's standard medical needs, you probably receive a lot of paperwork. Some of it isn't easy to understand, and sometimes it's not clear if what you received is a bill for services. 

Explanation of Benefits (EOB) are statements from the insurance carrier regarding every item billed by a provider. For example, you may go see your primary care physician for an infected finger, but while you're there you may also discuss your current medications, and have your sinuses checked for polyps. Each separate procedure will be submitted to the insurance carrier with a medical billing code, and the insurance carrier decides based on those codes what and how much to pay.  

Those are the codes that will appear on your Explanation of Benefits. At the bottom of the statement, normally in small print, there will be a legend defining each code. Sometimes those codes are easy to understand--maybe one is simply the code for fifteen billable minutes while another may specifically be for polyps. The insurance carriers response will also be in code, ie the code for paid in full, or the code for denial. 

Explanation of Benefits are never bills; they are merely for your information and records. You may receive a bill from the provider for the balance remaining after the carrier's payment, or for the full amount if the carrier denied the claim or you have not yet reached your deductible. 

Have you received an explanation of benefit or a denial that you don't understand? Please let us know so we can help. We will walk you through how to read the EOB, what denials can be appealed, and how to submit the information to the carrier for reconsideration. 

Have you received a separate bill from the provider? We will help you understand what that bill is for and work on your behalf with the provider to have it reduced, settled, or forgiven. 

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