EOB, the More You Know . . .

EOB. Explanation of Benefits. A document that is mostly ignored and misunderstood by way too many people.      


Your EOB is just as important as your bank statement or credit card bill. Yet far too many people never bother to read them.

Most health insurance EOB's are laid out well and relatively easy to decode. The billing codes and carrier explanations usually appear at the bottom of each page, or on the back if you get a paper EOB. Most plans also have online versions that can be viewed and printed.

Like your credit card statement, the EOB does you no good unless you check it each month.

Compare your Explanation of Benefits statement against your medical bills for each service. Doctor, lab, hospital, pharmacy, etc. Every medical provider that has your insurance information is required to file claims on your behalf with your insurance carrier. Par providers have time limits in which they must file or forfeit their right to collect from the carrier or patient.

A common health insurance complaint on consumer forums deals with "mysterious" medical bills showing up a year or more after service was rendered. Often the individual finds out about it when they apply for credit and discovers a black mark on their report, or when they get a collection notice.


What happened to the bills from the medical provider? Do you ever open your mail?

Sometimes the patient bill is never generated by the provider's office due to an oversight. The shortfall is discovered during a routine audit.

This is where you need to get cozy with your EOB. If the provider was in network, and they never filed the claim with your health insurance carrier, you are probably not liable for the bill.

Regardless of whether the provider is par or non-par, or even if the provider filed the claim or not, YOU, the patient, are ultimately responsible for the bill. Failing to pay can impair your credit. Failure to pay could mean a denial of services in the future.

Check your EOB on a regular basis, especially if you frequently use medical services. The more you see a doctor, have lab work or diagnostic services, the more diligent you need to be in checking your EOB.