If you ever received a medical service and used your insurance, you have surely received a lot of paper in the mail or electronically. Do you know the difference between all of them? The most important distinction is between Explanation of Benefits (EOBs) and statements from your provider. Why? One is a true bill, one is not.
So what’s the difference? An Explanation of Benefits (EOB) is your insurance company’s way of informing you that they know you’re covered, they looked at the claim your provider sent them, and here’s how much they calculate you’ll owe. It’s an FYI.
At the same time, your insurer sends this information back to your medical provider – along with their payment to them. Then, it’s your provider’s turn to take that info and – voila! -put together a bill for you.
Now that you’ve got the sequence of events, that means a few things for you:
1) An EOB is only an FYI. To be certain about the amount you owe, wait for a bill from your provider to verify the amount.
2) EOBs usually arrive before a bill. So when you see a new EOB, you now have a sense of what to expect. If you receive a bill before you get an EOB, check to make sure your insurance paid and you aren’t getting billed for the full amount.
3) At the end of the day, your provider is who you owe. Don’t send money to your insurance company for an EOB!
4) You could owe less. Your provider may further adjust the amount you owe with additional discounts, but you should never pay more than the EOB shows. Your provider cannot bill you for something the insurance company did not pay if it wasn’t described as your responsibility in your EOB.