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Glossary Terms

What is an Explanation of Benefits (EOB)?

Glossary

An Explanation of Benefits (EOB) is a statement from a health insurance plan describing what costs it will cover for medical care received. The EOB is generated when a provider submits a claim for services.

The EOB accompanies the billing statement to provide detailed information on:

  • The cost of care received
  • What the insurance plan did and did not cover
  • What the insurance plan has agreed to pay
  • Adjustments the payer believes should be made
  • The balance the patient owes
  • Any money saved by visiting an in-network provider
  • A list of out-of-pocket medical expenses the patient is responsible for

An EOB is not a bill but is designed to help patients and providers understand their bills and the benefits they are receiving.

What Does an EOB Include?

Although EOB statements vary depending on the insurance company, they all feature the same basic components. These include an account summary, claim details, the amount charged by the provider, and the amount the insurance covers.

The statements will also list the difference, or discount, between what the provider charged and what the insurance paid. This is sometimes noted as an “adjustment,“ an “allowed amount,” or — in some cases — a “contracted agreement.”

On most (but not all) EOBs, there will be a section describing any copays, coinsurances, or deductibles that have been applied.

What Should You Do With an EOB?

Patients should save and review their EOB until they receive their physician's or provider's final bill. Compare the amount owed on the bill to the amount owed on the EOB. Most of the time, they will match, and that’s the amount patients need to pay.

If the amounts on the final bill and the EOB don’t match, patients should contact the provider’s billing department and request an itemized bill. Cross-referencing this with their EOB statements will help determine where any billing mistakes occurred.

If an issue can’t be resolved with the provider’s billing department, an appeal should be filed with the insurer.

How TempDev Can Help With Your EOBs

TempDev's team of consultants, developers, and trainers can help whether you're looking to upgrade your current EHR system or install one from scratch. From dashboards and revenue cycle consulting to automation and workflow redesign, TempDev offers tools to make the most of your NextGen EHR system, along with top tips and tricks that will ensure your success now and in the future.

You can better support your patients' needs with TempDev's NextGen dashboards, templates, and reports. Our team is here to help you design, organize, and implement the entire system.

Contact us here or call us at 1-888-TEMPDEV to ensure you're utilizing EOB statements correctly in your billing processes.

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