Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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The lowdown...

  • An explanation of benefits (EOB) is not a bill
  • Correspondence from a health insurance does not have your diagnosis on it
  • EOBs include patient name, date of birth, provider’s name, date of service, and an explanation of what’s paid

Are you curious as to what information shows up on a health insurance bill? The first thing to understand is that the information you receive from your health insurance after services are rendered is not a bill.

What happens is your provider, usually a doctor’s office, submits a bill to your insurance. The bill lists services that were provided to a patient. It’s necessary for a physician’s office to list the services received to pay the claim on your behalf.

Most insurance companies send an explanation of benefits (EOB) to insurers after payments have been made to the physician’s office. In some instances, the insurance may send an EOB before the claim is paid to alert you the claim was filed, or notify you there was an issue with the claim.

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How to Read an EOB

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Many people confuse an EOB with a health insurance bill because it breaks down how much the doctor charged, what the insurance company has agreed to accept as payment in full, and any amounts owed to the provider by the patient.

Patients may end up owing their physician money for copays, coinsurance, deductible amounts, or services that were denied by the insurance company. Many times amounts paid at the date of service such as co-pays aren’t reported on an EOB from the insurance company. This is because the doctor’s office doesn’t divulge that information to the insurance company.

So, you should only remit payments to the office after you have confirmed that you owe it and haven’t already paid for it. It’s important to remember that an EOB is not a bill.

If you’ve paid your copay and coinsurance and have a remaining balance, your physician’s office will charge you directly.

You may also receive a statement from your doctor’s office when they bill your insurance company. The statement will show the amount charged for the service; the date services were rendered, and what the service was.

For example, if you had an adult wellness exam, the statement would state the CPT code for the exam and the name of the service as well as the cost. If you receive a statement from your physician’s office before your insurance pays, it is not a bill. It’s simply a notification stating the insurance was charged.

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Not All Insurance Companies Send EOBs

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It’s also important to realize that not all insurance companies send EOBs. Also, not all doctors’ offices send statements when they bill insurance. Depending on your insurance company and doctor’s office, you may receive health insurance notifications from one, both, or none.

It’s important to know how to read your insurance statements and billing statements, so you understand the process. Below are several things you should be aware of the relationship between your physician’s office and your insurance company.

When to Contact Your Insurance Company

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Sometimes, it can be confusing to determine whether you should call your insurance company or your doctor’s office. Making things even more complicated is the fact not only insurance companies operate the same way.

However, there are a few times when you should contact your insurance company before contacting your physician’s office. Below are instances that require you to call your insurance company.

  • Insurance company didn’t cover a service you thought it would of or should have covered
  • If your insurance company hasn’t paid a claim and more than 60 days have passed since the date of service

It’s important to keep all EOBS and statements from your doctor’s office and insurance company. Keeping copies of all your insurance EOBs and statements allows you to reconcile your records and keep track of any amounts owed to your doctor.

It’s also vital that you review your benefits every time your insurance renews or changes.

By keeping track of your health care benefits, you can make sure you understand what is and isn’t covered and how and when you may owe money for services not covered.

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