What is EOB in medical billing?
Asked by: Freeman Kassulke | Last update: April 7, 2025Score: 4.1/5 (51 votes)
What does EOB mean in medical terms?
What is an Explanation of Benefits? An EOB is a statement from your health insurance plan describing what costs it will cover for medical care or products you've received.
What is the difference between a claim and an EOB?
A claim is a request for benefits (payment) that's filed with your health care insurer, either by you or your medical provider. An EOB is a summary that is sent to you after that claim is received. It provides information about what was covered, how much was paid out to the provider, and what you still owe.
Who provides the explanation of benefits?
Each time your insurer pays for a service you use, they send you an Explanation of Benefits (EOB). The EOB is your insurance company's written explanation for that claim, showing the name of the provider that covered the service and date(s) of service.
Who gets the EOB?
Usually, the insurer sends the EOB to the primary person on the health plan. If an employer provides the insurance, the employee usually receives the EOB, including EOBs for a spouse and dependents on the plan.
What is an EOB?
Who receives the EOB?
Around the time you receive your patient billing statement, you will also receive an explanation of benefits (EOB) from your insurance provider. An explanation of benefits is a document that explains how your insurance processed the claim for the services you received.
Does a bill come after an EOB?
So, no, you shouldn't pay anything yet. It's a report of what your insurance plan is going to cover, based on the care you received, and your health plan benefits for that care. If there's an amount you owe noted on the EOB, you will receive a separate bill from your doctor for the portion that you need to pay.
Have an EOB but no bill?
If you have insurance
An EOB is not a bill. An EOB is a summary of the care that you received and shows the amount your insurer is billed, how much your insurance will pay for that care, and the amount that you will owe.
How do I get my EOB?
EOBs are usually mailed once per month. Some plans give you the option of accessing your EOB online. Your EOB is a summary of the services and items you have received and how much you may owe for them.
Does Medicare send EOBs?
Your plan will mail you an EOB each month you fill a prescription, visit a health care provider, or file a claim. This notice gives you a summary of your claims and costs. For more up-to-date claims information, contact your plan.
What happens if I pay more than my EOB?
If your provider is charging you more than your EOB shows, we encourage you to talk to your provider directly and ask that your bill be adjusted. If you've already paid more than your EOB says that you owe, you will need to request a refund from your provider or facility directly.
How many years to keep an Explanation of Benefits?
If you didn't report income you should have reported, hold onto your documents for six years. Outside of the IRS guidelines, it's generally recommended to keep EOBs for three to eight years after receiving medical care. Explore additional guidelines based on health.
Is a patient responsible for denied charges?
Most insurance companies have time limits to file a claim. If the healthcare consumer claim was denied for this reason, the consumer should not pay the bill. It is the responsibility of the healthcare provider.
What is the provider responsibility on the EOB?
Provider Responsibility Amount: Amount of the billed charges that the provider covers. Network providers shouldn't bill you for these charges — but out-of-network providers can bill you for them. Amount You Owe: Amount you pay the provider when you get their bill.
How long does it take to get an Explanation of Benefits?
Typically, you'll receive an EOB shortly after a visit to a provider or after you make a purchase covered by your insurance — such as a prescription or piece of medical equipment.
Which of the following is a common reason why insurance claims are rejected?
The claim has missing or incorrect information.
Whether by accident or intentionally, medical billing and coding errors are common reasons that claims are rejected or denied. Information may be incorrect, incomplete or missing. You will need to check your billing statement and EOB very carefully.
How do providers submit claims to Medicare?
How to Submit Claims: Claims may be electronically submitted to a Medicare Administrative Contractor (MAC) from a provider using a computer with software that meets electronic filing requirements as established by the HIPAA claim standard and by meeting CMS requirements contained in the provider enrollment & ...
How often do you get an EOB?
What is it? Each month you fill a prescription, your Medicare Prescription Drug Plan mails you an "Explanation of Benefits" (EOB).
How to explain an EOB to a patient?
- “Provider Charges” is the amount your provider bills for your visit.
- “Allowed Charges” is the amount your provider will be paid. ...
- “Paid by Insurer” is the amount your health plan will pay to your provider.
Should I worry about EOB?
If it is Not a Bill, Why is the EOB Important to Me? You should keep your Explanation of Benefits documents (shortened to EOB) in an organized system. You can sort your EOBs by date of service and reference them as you progress through the insurance and payment portions following your care and medical treatment.
Will insurance pay if you leave against medical advice?
Leaving AMA will not result in a refusal of payment. It will not trigger an increase in your insurance premium, either. It is possible, though, that you will have more medical expenses if you have to be readmitted because of the early discharge. Leaving AMA increases the risk of readmission.
Why am I being charged more than my copay?
Non-Covered Services: Some medical services or prescription medications may not be covered by your insurance plan. If this is the case, you will be responsible for the full cost of the service or medication, which may exceed your copayment.
How long should you keep an EOB?
Comparing your EOBs to your monthly statements is a good way to understand what you are being charged for, and it gives you another opportunity to look for overcharges. Unlike medical bills, EOBs should be kept from three to eight years after your procedure, or indefinitely if you have a reoccurring condition.
What happens if EOB and bill don't match?
You should use what you learn to review your EOBs and billing statements carefully. Here are some things to look for: If the dates of service and description of services on your EOB and billing statement aren't the same, or if they don't match other records you may have of the visit, contact your doctor's office first.
Can providers charge more than EOB?
Anything billed above and beyond the allowed amount is not an allowed charge. The healthcare provider won't get paid for it, as long as they're in your health plan's network. If your EOB has a column for the amount not allowed, this represents the discount the health insurance company negotiated with your provider.