The Value of Explanation of Benefits
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The Value of Explanation of Benefits 

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Insurance Document Holds Valuable Information

By Tamara Turner

Norfolk, VA (April 2010) - If you have health insurance, you’re familiar with the Explanation of Benefits that you receive shortly after you have utilized services, such as visiting your physician or having lab work. But do you really look at this document carefully?

The Explanation of Benefits, or EOBs as the insurance companies call them, is an explanation of the benefits and services used by a health plan member for which a healthcare provider has requested payment. In essence, it explains how the health insurance plan has paid claims processed by your healthcare provider. This is an important document for understanding and tracking the healthcare services you have used during a plan year. If you’re like most people, you glance over the EOB mainly looking for your expected out-of-pocket costs, but not paying much attention to the actual cost of care or the amount the provider is being reimbursed.

Why is the EOB important? First, it’s a way for you to track and monitor your healthcare expenses. Since most Americans get their health insurance through their employers, and more employers are moving toward high deductible health plans, tracking takes on an even more important role. Under these plans, generally premiums are lower but deductibles are higher. So monitoring how much you have spent toward meeting your deductible is important.

Second, carefully reviewing your EOB can alert you to any potential discrepancies. Not that you should assume there will be errors, but by careful review you are more likely to find any mistakes. On a more serious note, if you ever suspect the potential of any healthcare fraud based on information you see on your EOB, contact your health plan immediately for guidance.

Third, your EOBs are your guide to managing your own healthcare. This will help you to evaluate those anticipated costs so that you can better plan for your out-of-pocket expenses. If you have a healthcare spending account, such as a flexible spending account (FSA), health reimbursement arrangement (HRA) or health savings account (HSA), you can better determine your costs for the next health plan year. In the end, a careful review of your EOBs makes you more aware of the costs of healthcare so you can make good decisions for the future.

State and federal guidelines require health insurance carriers to provide their members explanations when they have out-of-pocket expenses. Carriers do this in the form of the EOB. Most carriers offer an online version of the EOB as an alternative to mail, which also is a great green measure. If you have any questions regarding your claims, or if a claim has been denied, contact your carrier’s member services department for clarification. Keep in mind that all carriers have an appeals process equipped with healthcare professionals who can review the claim.

The EOB is your key to understanding and interpreting your health plan benefits. Use this tool wisely to gain better control over your healthcare.


Tamara Turner is the Director of Operations at Optima Health, a Virginia-based health plan with more than 425,000 members, nationally-recognized for its quality, service and innovative programs.

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