How to Read an Explanation of Benefits (EOB) Statement

When dealing with any part of the government, it can be confusing trying to wrap your head around all the information you receive in the mail regarding insurance and the like. For this article, we’ll take a look at what an E.O.B. is—we’ll define it for those who may not know and break down the information so you can easily understand how it works. Hopefully, by the end of the article, you’ll have a better understanding and maybe not want to rip your hair out trying to figure things out.

Let’s begin.

Simply put, an E.O.B. is an Explanation of Benefits. For our purposes, let’s use an example of Blue Cross Blue Shield. After going to the doctor, you will get an E.O.B. statement in the mail which details the type of medical care that their insurance covers, as well as the services they are unable to pay for (and why), and any charges that you might owe out of your own money. 

Now, let’s look at what exactly is on the statement, one at a time.

First, you’ll find your member contract information. This includes your name, address, and the group and contact info that’s on your insurance card. You’ll also find the name of your family member that received the medical care.

Next, you’ll find the customer service contacts. The statement comes with a toll-free number and address to contact your insurance provider with any questions you might have regarding your statement. You’ll also see this information on your enrollee ID card.

A summary of services follows, and this lists the types of medical services that you, or a family member, received within the time since your last statement date. Also listed will be any savings you received through participating providers and any charges you might owe. Be sure to match this information with your bills to make sure it’s accurate.

A summary of deductibles and copayments is next, which shows just how much of your co-pays and deductibles are paid to date.

Details of services are also listed, and these show what kind of care you received the date of the appointment and your doctor’s name. Be sure to compare the information here with that on your health care bills.

Finally, your balance, which will show you just how payments are calculated and let you know of any balances you might owe.

While it can be initially confusing trying to sort all this stuff out, it doesn’t have to be, and when taken in part, it can actually be a lot easier than you’ve probably thought. Hopefully, this quick article helped to shed some light on what you can expect when you receive an Explanation of Benefits—whether you’ve gotten them before, or your first time is coming up soon.