The IAA One Minute Blog

When you receive an Explanation of Benefits (EOB) in the mail, it may seem confusing. There are so many columns and numbers that seem impossible to decipher. Though it seems difficult, Insurance Administrator of America is here to reassure you that it isn't hard at all.

What is an EOB?

First, it is important to understand what an EOB is. An EOB is not a bill; it is information reviewing how a provider was paid for services performed on you or a family member on your insurance policy. When you receive the EOB, you should review it to determine if there are any billing discrepancies. There are times when a provider's office accidentally invoices your insurance company for services you did not receive. An EOB also shows the members' estimated payment responsibilities once the bill is processed. The information in a member's EOB can help them understand how their insurance benefits were applied to every claim reported to the insurance company.

Different Parts of an EOB

Insurance companies have their own versions of an EOB, but there are some parts that are universal. Here is some universal terminology to help you better understand what you're reading:

• Allowable Amount: The amount the insurance company and provider's office has agreed is the amount that will be paid for, for that particular procedure.
• Co-insurance: The percentage the patient owes for the procedure.
• Co-pay: The set amount of money a member owes for the procedure.
• Non-covered Charges: The charges the insurance policy does not cover in their contract.
• Deductible: The amount that has to be reached before the insurance company starts paying medical bills.

There are a number of parts to an EOB, but that should not deter you from trying to read and understand what they are:

1. Claim Summary Section: This section lists a provider, which is where or whom the services were rendered (name of doctor, clinic, laboratory). It also lists a unique claim number for each service and visit.
2. Payment Summary Section: This is where you will find the dollar amounts listed for charges submitted to the insurance company and out-of-pocket costs.
3. Claims Details Section: Where you find a claim's corresponding type and place of service, as well as a specific date when the service was provided.

Take an IAA EOB as an example:

• Enrollee, patient, and claim information is all grouped together on the right-hand side.
• The "Claim Summary" box (located right underneath the enrollee and patient information) details the patient's total responsibility and carrier payment.
• Code descriptions and explanations are grouped together at the bottom of the EOB.
• All information from "Date of Service" to "Plan Payment" flows smoothly, easy to decipher and understand.

Last Minute Tips

Here are some last minute tips to help get the most out of your EOB:

• If there is misinformation on the EOB, it might be due to clerical error or identity theft. Contact the insurance company immediately if you feel that is the case.
• Any amount or charges denied may be re-evaluated with additional information.
• You should keep an EOB for at least a year.

What IAA has to Say

When you receive an EOB in the mail, it should not be something you toss away. It should be something you look over and keep for some time. With IAA, you get an easy to read and comprehend EOB. With these tips and explanations from IAA you'll be able to understand any and all EOBs sent to you. Just think of IAA as your professor for Reading an EOB 101. Class dismissed.

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