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Reading Your Payer's EOB - Explanation of Benefits

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Updated February 21, 2009

When you decide to take steps to control your health costs, knowing how to read your health insurer's, Medicare or other payer's paperwork, called an EOB, Explanation of Benefits, can be helpful.

There are three pieces of paperwork you'll need to compare.

  1. The list of services performed. This is handed to you when you leave the doctor's office or testing site.

  2. The bill the doctor or health facility sends you. It is a list of the services from #1 above, and the charges for each service.

  3. The explanation of benefits -- EOB -- that comes from your payer (insurer, Medicare or other payer). This article describes the information on your EOB.

Among the three pieces of paper, you'll find terminology and codes that will help you be sure you are being billed only for the services that were performed.

First: We'll look at the services listed on the EOB.

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A basic EOB statement will have similar pieces of information.The Basics of an EOB - Explanation of BenefitsFind a list of services acknowledged by your payer on your EOB.Step 1 - Finding and Aligning Services on Your Explanation of Benefits (EOB)CPT codes on the EOB should sync with the codes on your medical bill.Step 2 - Aligning CPT Codes Between Your Medical Bills and EOBsThe EOB reflects both the amount charged and the amount reimbursed.Step 3 - Taking a Look at the Cost of Service and the Provider's Reimbursement
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  6. EOB, Explanation of Benefits - Reading Your Insurance EOB (Explanation of Benefits)

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