What is EOB Meaning, Definition in Medical Billing & Insurance

You can find details of EOB and its definition in medical billing & insurance in the article below.

EOB is an acronym for Explanation of Benefits is a primary communication between health insurance carriers and their customers. It often seems like a medical bill but on the top of the EOB paper it is clearly mentioned that “THIS IS NOT A BILL.” But still patients think that it is a bill because it seems like a medical bill. It states that they are responsible for a set sum of money, or a service on their healthcare claim was not covered by their insurer.

Patients do not collect bills for medical services from their insurers. The healthcare providers send out bills for services provided. What the patient receives is called an EOB (Explanation of Benefits) alternatively termed as summary of Benefits, Remittance Advisory or Beneficiary Notice.

After you receive medical services, the hospital, clinic or doctor’s office bills your health insurance before it bills you. Your insurance company then analyzes the bill, then pays a portion based on your insurance benefits and its contract with the provider, and then sends you an EOB.

Definition and purpose of EOB

An Explanation of Benefits, or EOB, is a paper or electronic document you’ll receive after you see a physician or other health care professional, at the time your claim is processed. It gives a details regarding how the insurance company processed medical insurance claims. The EOB tells what part of a claim was paid to the health care provider and what portion of the payment you are responsible for. On the EOB you’ll find claims and patient payment information for you and your covered family members in a single statement.

EOB purpose is to make you understand about health care coverage. It is a simple way to see the whole process information in one place and also to track health care services or expenditures.

Explanation of Benefits & Medical Billing

Health care services are translated into a billing claim by Medical billing. The medical biller is responsible in a healthcare facility is to pursue the claim to guarantee the practice receives reimbursement for the work the providers do.
Payment follows after a claim processes in medical billing. Every payment is accompanied by an explanation of benefits, or EOB. The explanation of benefits is sent to the patient and the provider to show how the claim processed. It also inform the provider whether any remaining balance is unpaid by the patient. The biller/coder needs to review the documentation to make sure that the claim has processed and paid properly.

An EOB usually includes the details explaining how the claim was processed, although some payer EOBs show only the total claim amount, along with the total provider write off, and the sum allowance. In such circumstances, it is up to the designee, to break the payment out to show the detail.

Explanation of Benefits & Insurance

Health insurance companies send EOB to communicate their verdicts to covered members about payment for services. EOB of every insurance company is different, and all are not easy to understand. An EOB is not a bill, but it entails sufficient information for the member to review what the physician will finally be billing them. Understanding health insurance language is very helpful in reading the communications between the doctor, an insurance company, and the service taker himself.
The doctor or hospital is known as the “provider” in the health insurance world because they provide services the “member.” Insurance companies’ group large number of people with the multiple insurance plans so the insurance companies benefits according to signed up plan.

There are many different versions of an EOB. The most common layout style used is the Standard Paper Remittance format. This layout is most commonly used by Medicare. The information displayed is usually the same and each payer has the choice to convey the information in their desired layout.

An EOB helps you to avoid paying extra than you should for medical care. In case you find an error on a bill from a doctor or health care provider while EOBs are processed by your insurance company, you can call to give details that your EOB illustrates that insurance paid on the claim and have a billing error. Simple errors can regularly be corrected by contacting the provider.