If you’ve ever visited a healthcare provider or filled a prescription under your health insurance plan, you’ve likely received an Explanation of Benefits (EOB). Understanding your EOB is essential for managing your healthcare expenses, keeping track of claims, and ensuring accuracy in billing. Here’s a closer look at what an EOB is, how to read it, and how deductible services work—especially if you’re enrolled in JGM’s benefits program.

What Is an Explanation of Benefits (EOB)?

An EOB is a document that your health insurance provider sends after you receive medical services, such as a doctor’s visit, diagnostic tests, or treatment. It is not a bill but rather a detailed summary that explains:

• What services you received
• The cost of those services
• What your insurance covered
• What portion you are responsible for paying

How to Read an EOB

While formats may vary slightly between insurance providers, EOBs generally include the following key sections:

1. Patient Information: The name of the individual who received the service.
2. Service Details: The date and type of service provided (e.g., office visit, X-ray, lab test).
3. Provider Information: The name of the healthcare provider or facility.
4. Amount Billed: The total charge submitted by the provider.
5. Allowed Amount: The amount your insurance company has agreed to pay for the service. This is usually lower than the amount billed due to negotiated rates with in-network providers.
6. Insurance Payment: The portion of the allowed amount that your insurance plan covers.
7. Your Responsibility: This includes any copay, deductible, or coinsurance you owe.
8. Reason Codes and Notes: Explanations for adjustments, such as denied claims or services not covered.

Deductibles on Your EOB

Your deductible is the amount you must pay out-of-pocket before your insurance starts covering certain services. The EOB will indicate whether the costs of a service have been applied to your deductible. Here’s how:

• Applied to Deductible: If a service falls under your deductible, the full allowed amount for that service will appear in the “Your Responsibility” section. This indicates that you need to pay this amount directly to the provider.
• Covered After Deductible: Once you’ve met your deductible, your EOB will show how much your insurance has paid and the reduced amount you owe, if any.

Tips for Managing Your EOBs

• Check for Errors: Review your EOB carefully to ensure accuracy in billing and insurance coverage. Report any discrepancies to your insurance provider promptly. Incorrectly coded services from a provider can cause denial of coverage. You can always check with your provider as well.
• Keep Records: Maintain organized records of your EOBs for future reference, especially if you’re seeking deductible reimbursements.
• Ask Questions: If you’re unsure about any details on your EOB, don’t hesitate to contact your insurance provider or JGM’s HR team for assistance.

Conclusion

Understanding your EOB empowers you to make informed decisions about your healthcare and finances. By staying on top of your EOBs and taking advantage of JGM’s deductible reimbursement program, you can better manage your out-of-pocket expenses while maximizing the value of your benefits package.