The 123s of EOBs: How to make sure you're not paying too much for care

A friend of mine raised in Uruguay recently hosted a holiday party. While he speaks English very well, many of his friends don’t; as a result I couldn’t fully appreciate the conversation. I was missing out on a great deal. I didn’t know the language, and no matter how engaging or exciting the conversations were, I only understood a fragment of what was going on.

This is how many of us feel when dealing with the health care system. It’s another language, full of legal and regulatory laws, strange terminology, and confusing paperwork. And when it comes to paperwork, nothing generates questions like the EOB.

EOB stands for Explanation of Benefits (EOB) – they’re intended to be informational and helpful. But that isn’t always the case. So let’s help clear things up a bit.

First things first. You have an appointment with a doctor, a hospital, or any health care provider – once the provider submits a claim, in most cases you can expect to receive an EOB within 30 days, unless additional information is needed. You won’t always get an EOB, especially if you had to pay a copayment at the time of your visit.

The EOB provides you with important information, including:

• A summary of the services received
• Cost of those services
• Discounts received as a BCBSNC member
• Amount BCBSNC will pay
• Amount you may have to pay

You should keep all EOBs and verify them against medical bills to make sure you’re being charged the right amount. It’s important to keep these to paint that full picture of your visit, especially if you have complicated or long-term medical conditions.

The EOB can help you track your health care spending or medical claims history. Compare the EOB with the bills you get from your doctor or health care facility.

If something doesn’t look right to you, contact the health care provider to discuss the claim in question right away. You can also call the customer service number listed on your insurance card. If you can’t agree on the coverage, you have the right to appeal by following the steps listed on the back of the EOB.

When reading your EOB it’s important to remember that the document is not specific to one procedure or visit. It’s a snap shot of the claims processed that day. Many factors go into the contents of your EOB, such as when and how the provider submits the claim. So an EOB may only have a portion of charges listed. You should keep all EOBs and verify them against medical bills to make sure you’re being charged the right amount.

If you have any additional questions about your EOB or a specific claim, please call the Customer Service number listed on your insurance ID card. You can also sign in to Blue Connect our secure site to manage your account and see claims activity, review your benefit information, and  make changes to your plan.