After healthcare is provided, you may receive an Explanation of Benefits from your insurer and a separate bill from the provider. Learn what each document means and what to compare before paying.
The amount submitted by the healthcare provider for the service.
The amount recognized by the plan under applicable coverage and network arrangements.
The amount the insurer indicates it paid or will pay under applicable plan terms.
The amount the EOB indicates may be your responsibility through deductible, copay, coinsurance or other applicable terms.
Explanations for how portions of the claim were processed, adjusted or not covered.
The exact process varies, but this simplified flow can help explain why an EOB and provider bill may arrive separately.
Ask about coverage, network processing, deductible application, denial reasons, claim status or applicable appeal information.
Ask about services billed, coding, payment posting, account balance or whether a corrected claim may be needed.
Save relevant EOBs, bills, claim numbers, correspondence and notes from calls while an issue is being reviewed.
Use BenefitRoute's glossary whenever an insurance term on an EOB, plan document or medical bill is unfamiliar.
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