When you use medical services from a healthcare provider, you will receive an explanation of benefits (EOB) from your insurance company. Some people get confused about their EOB, but there is nothing to be nervous about. The EOB is simply a written explanation from your insurance company regarding the received medical services, the amount they cover, and whether you need to pay something.

Read on to learn more about the explanation of benefits and whether EOB is the same as a medical bill.

What Does an Explanation of Benefits Look Like?

Most people check what nearby medical practices are in-network with their insurance provider. That means the insurance company covers the costs of certain medical services.

So, you visit a doctor and get the medical help you need. The practice asks for your insurance information, and it is on them to charge the insurance company for the services they provide to you. They do that by submitting claims, and once everything is cleared, they receive a payment from the insurance provider.

Once the insurance company receives and processes their request, they send you an EOB informing you about the submitted claim. So, the EOB contains information about provided medical services and how much they cost. In addition, it tells you what part of your medical bill is covered by your insurance policy and whether you’ll have any additional charges.

Is Explanation of Benefits a Medical Bill?

If it’s one of the first times receiving an EOB, you may confuse it with a medical bill. However, EOB is not a medical bill; it only provides information about received medical services and how the insurance will cover the cost. 

Sometimes, the insurance doesn’t cover the entire cost of your medical treatment, and you will be charged to pay the outstanding balance. However, you’ll receive a separate medical bill for the amount you owe.

How to Read an Explanation of Benefits

A typical EOB contains three pages, and they try to explain all the details regarding the services and medical costs you received.

For instance, the first page summarizes the majority of information. It usually contains:

  • Your personal information
  • Received medical services
  • Information about the medical practice you visited
  • Total costs
  • Discounts for an in-network medical provider
  • The amount covered by your insurance plan
  • The amount not covered by insurance
  • The outstanding balance you need to pay

The second page gives you more information about the medical terms and definitions used on the first page of your EOB. It also gives you more details on how to submit an appeal if the EOB you received doesn’t reflect the actual services provided or if there is another issue.

The third page covers received services in more detail and may provide additional information about your deductibles.

Outside Help for Medical Practices

If you are a practice owner and need help streamlining processes and improving efficiency, Peregrine Healthcare is here for you. We take a personalized approach to boost revenue and improve different aspects of your medical practice.

Click here to learn more about our services and how we can help take your medical practice to the next level.

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