After your doctor’s appointment, your doctor’s office submits a bill (also called a claim) to your insurance company. A claim lists the services your doctor provided to you. The insurance company uses the information in the claim to pay the doctor for those services.
When the insurance company pays your doctor, it might send you a report called an Explanation of Benefits, or EOB, that shows you what it did. You need to be able to read and understand the EOB to know what your insurance company is paying for, what it’s not paying for, and why. An EOB is not a bill.
Your doctor’s office might send you a statement. A statement shows how much your doctor’s office billed your insurance company for the services you received. If you receive a statement before your insurance company pays your doctor, you do not need to pay the amounts listed at that time. After your insurance company pays your doctor, you may need to pay the doctor any balance due.
Keep in mind that not all insurance companies send EOBs, and not all doctors’ offices send statements. You may receive one or the other or both.
The next page shows a sample EOB and a billing statement with instructions to help you understand them. You should use what you learn to review your EOBs and billing statements carefully. Here are some things to look for:
- If the dates of service and description of services on your EOB and billing statement aren’t the same, or if they don’t match other records you may have of the visit, contact your doctor’s office first.
- If you have questions about why your insurance company did not cover something or about the amount you have to pay, contact your insurance company.
- If more than 60 days have passed and your insurance company still hasn’t paid your doctor, contact your insurance company.
Finally, you should keep your EOBs and statements organized (e.g., filed by date) so that you can access them easily should questions arise.
View an example of an EOB that includes helpful definitions and explanations.