What is an Explanation of Benefits (EoB)?

What is an EoB?

An Explanation of Benefits (EoB) is a document your insurance provider will send you in the mail to tell you if they’re processing your hospital bill. If they are, various pieces of data will appear on the bill, generally falling into one of five categories:

• General data, including health plan information, who provided care, when care was provided, and the claim number

• Claim details, include the date of service and a service description

• Billing information, including provider charges, allowed charges, and how much the insurer paid

• Patient balance, which is what you as the patient owe; your bill will never exceed your patient balance, but if you’ve already partially paid, the bill will not reflect that

• Remark code, which further explains the details and processing of the claim

How is this used?

An Explanation of Benefits has a few critical pieces of information that you, as the patient, need to be able to read. Between general data and billing information, you can look into the details to calculate how close you are to your deductible, whether any billing errors occurred, and, if anything got denied, a point from which you can start your appeal.

FAQ

What’s the difference between an EoB, an AEoB, and a COB?

An Explanation of Benefits provides you, the recipient of care, with important insurance information for how you will be billed and how much you will have to pay. An Advanced Explanation of Benefits, or AEoB, lets patients know the expected cost of care in advance of their procedure; it became mandated in 2022 when the No Surprises Act went into effect. Coordination of Benefits, or COB, applies when an individual has multiple insurance plans and ensures that the insurers collectively pay no more than 100% of the bill.

What if I don’t receive an EoB?

You can check your online portal with your insurer to find a digital version of it there. If it isn’t there, reach out to your insurer and ask them to send you one.

Conclusion

We hope this article answered all your Explanation of Benefits questions! At Fairdoc, we are here to inform you, assist you, and answer all your questions. If you have any inquiries for us, feel free to reach out, and stay tuned for future articles!