HOW TO READ AN EXPLANATION OF BENEFITS

Every time your or a covered family member receives healthcare from a doctor, laboratory, clinic, hospital or other healthcare provider, and you are responsible for payment for that healthcare, you should receive an Explanation Of Benefits (EOB).

An EOB is not a medical bill. It is an itemized statement with a great deal of information, such as the specific healthcare service you received, how much was charged for that service, what was paid to the doctor or provider and what you owe. You receive an EOB only when you owe additional money beyond your typical copayment.

An EOB is for your information and files. After reviewing the EOB, you have the right to appeal certain decisions regarding your claims. You can file an appeal in writing within 90 days of the date of the EOB notice. You should keep EOBs with your health insurance records for reference.

Click on the PDF below to view a description of your Explanation of Benefits (EOB). The numbers correspond with the numbers on the sample copy of the EOB on the last page.

For more on how to read a HealthSmart EOB, click here.

This is only a sample representation of an EOB.