EOB is an outcome of the claims process and is alternatively termed as a Beneficiary Notice, Summary of Benefits, Remittance Advisory or Coverage Determination.
EOB is NOT A BILL though it looks like one. It is simply an explanation of claim covered/not covered by the healthcare insurers to the healthcare provider along with any details of the patient being responsible for a sum of money left to be paid. It is sent on a monthly basis unless asked otherwise (via an online platform).
Components of an EOB:
1. Enrollee name: This section mentions the name of the insurance policyholder.
2. Patient Name: This section mentions the name of the patient who could be the enrollee himself or other family members (grouped under the enrollee’s name).
3. Patient Number: An identification number of the patient.
4. Enrollee address: This section contains the address and contact number of the policyholder.
5. Type of service/Products: This column lists the services/products that the patient has made use of from a healthcare provider.
6. HCPCS/CPT/ICD-10/Revenue codes: EOB could have any/all of these codes as per the services/products rendered by the patient.
7. Charge amount/Claim: This section mentions the amount charged by the healthcare provider.
8. Claim Number: A number in the computer system by which the patient and his/her claim is identified.
9. Date and place of service: The date and place on which the service was rendered.
10. Costing/charges covered: This section mentions the costs paid by the insurer for each service to the healthcare provider.
11. Payment amount/Benefit amount: The total amount paid by the insurance provider along with the benefits (percentage of the amount) paid.
12. Ineligible amount/Reason code: Along with a code, this column states the charges and the reasons due to which they have not been covered in the claim.
13. Other insurances: This section mentions the amount paid by an additional insurance provider.
14. Amount owed by patient: In case the patient hasn’t paid yet, then this charge is the patient’s responsibility: co-insurance, copay, deductible and/or non-covered services.
15. Process date: Date on which the insurance provider finalized its assessment on the claim.
The healthcare provider’s and the insurance provider’s information is also mentioned on EOB. The patient must ensure that he/she looks through the EOB thoroughly once received. Checking for the above mentioned points ensures that you are not being billed incorrectly for a service/product not rendered. You are also informed of your copay or deductibles.
In case of any error, contact your physician or the insurance provider to clear doubts. Keep your EOB statements up till a year and review your EOB carefully every time you receive it to avoid frauds and overcharging.