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At Resolve, we know that the insurance explanation of benefits can get confusing, especially when comparing it to your hospital bill. Learn how to understand your EOB, what each part in the document means, and tips for reviewing it from our team below.

What is an Insurance Explanation of Benefits?

The Explanation of Benefits (EOB) is a document created by insurance companies to communicate costs and coverage.

Explanation of Benefits

How do I get an Explanation of Benefits from my insurance company?

An Explanation of Benefits typically contains 4 parts:

  • Service Description: This section describes the service you received and may include a code associated with that service.
  • Provider Charges: This section summarizes how the provider (typically a hospital) has billed your insurer. It should present the same information on the amount billed, plan discounts, and allowed amount as detailed in your hospital bill
  • Paid by Insurer: This is the amount the insurer has paid to the provider. It should match the hospital bill.
  • Your Responsibility: This section itemizes the amount you owe by reason. Typical reasons include deductibles, copays, coinsurance and non-covered services.

Explanation of Benefits terminology to know

  • Deductible: Many insurance plans require you to cover a certain amount of expenses before their benefits kick in. This amount is the deductible.
  • Copay: The copay is a “shared” payment for services provided. Low copays ($20-$50) are common for doctor’s visit checkups, though sometimes your copay will be a percent of your total bill (generally around 20%).
  • Coinsurance: This is the percentage of your medical bill that you pay after you’ve met the deductible, with the rest being paid by your insurance company. 
  • Non-Covered: Insurance plans may not be required to cover certain services or services provided by certain providers.

Beyond understanding your EOB, you may also find it helpful to review these key health insurance terms when discussing your medical bill with your insurance company or hospital.

Tips for Understanding Your Explanation of Benefits

  • Check your EOB against your hospital bill: Compare each detail of your EOB to your hospital bill. Make sure your responsibility in the EOB matches your balance in the hospital bill. Ensure that the service descriptions, medical billing codes, provider charges, plan discounts and allowed amounts match.
  • Check the math on your EOB: Your Responsibility amount and the amount paid by your insurer should combine to equal the allowed charges.

If you have concerns about your EOB and medical bills and need expert help, get in touch with our medical bill advocates at Resolve today.