When you sign up for insurance, it’s important to understand the protection you’re actually getting. Many people don’t realize that there’s a form that could make all the difference in the event of a claim.

The form is called an “explanation of benefits” (EOB), and it’s important to request and review it before you sign anything.

What is an Explanation of Benefits (EOB)?

An EOB is a document that explains what medical treatments or services your insurance company will cover.

It includes information such as the doctors or hospitals you’ve visited, the date of your visit, the cost of the services provided, and the amount your insurance will cover. An EOB is not a bill and you should not be responsible for paying any amount listed on the EOB unless it’s your copay or deductible.

Why is an EOB so Important?

An EOB is important because it can help you verify that you’re receiving the coverage you’ve paid for. It’s not uncommon for insurance companies to make mistakes or deny claims that should be covered.

By reviewing your EOBs, you can ensure that you’re not overpaying for services or being denied coverage that you’re entitled to.

What Do You Look for in an EOB?

When reviewing your EOB, there are a few things you should pay close attention to:.

Services Provided: Make sure that the services listed on the EOB are accurate and that you actually received them.
Coverage Limitations or Exceptions: Be aware if there are any specific types of services that are not covered by your plan or any limitations on the amount of coverage you have for a particular service.
The Amount Billed: Verify that the amount your healthcare provider billed matches the amount on your EOB. If there is a discrepancy, you may want to call your insurance company to clarify.
Covered Amount: Check the amount your insurance company covers for each service and that your copay or deductible is correct.
Any Denials: If a service was denied, make sure to understand why, and whether it’s worth appealing the decision.

How to Get Your EOBs

Most insurance companies will send you an EOB in the mail after you receive medical services. However, you can also typically access them online through your insurance company’s website or mobile app.

If you’re having trouble accessing your EOBs, reach out to your insurance provider’s customer service department for assistance.

What Else Can You Do to Protect Yourself?

While reviewing your EOBs is an important step in protecting yourself, there are other things you can do as well, including:.

Choosing In-Network Providers: Make sure to use providers that are in-network with your insurance plan to avoid surprise bills or uncovered services. If you need to go out of network, be sure to get pre-authorization before receiving care to ensure that you’ll be covered.
Understanding Your Plan: Take the time to review your insurance policy and understand what’s covered and what isn’t. This will help you plan for medical expenses and avoid any surprises.
Asking Questions: Don’t be afraid to ask your healthcare provider or insurance company questions if you don’t understand something. It’s better to get clarification upfront than to be surprised by a bill later.
Keeping Records: Keep all of your medical records, including bills, EOBs, and receipts. This will be helpful if you need to appeal a denied claim or verify coverage in the future.
Appealing Denied Claims: If your insurance company has denied a claim that you believe should be covered, don’t be discouraged. You have the right to appeal the decision and provide additional information to support your case.

Conclusion

In conclusion, communication is key to understanding your insurance coverage and avoiding any unpleasant surprises. Take the time to review your EOBs and ask questions whenever you don’t understand something.

By doing so, you’ll be able to protect yourself and your wallet from unexpected medical bills.