An Explanation of Benefits (EOB) is a notification provided to members when your insurance company processes a healthcare benefits claim. The EOB outlines the expenses submitted by the provider and shows how the claim was processed. In most cases, an EOB will be mailed to you after a claim has been finalized. If you signed up for paperless statements, you would get an email when your EOB is ready for viewing through your member portal.
When you receive your EOB, don’t just toss it aside. It’s an essential record of claims for medical services and benefit coverage, so you should always carefully check your EOB. Double-check that the services you received match the services you’ve been billed for. Keep your EOBs on file for future reference just in case questions come up later about a claim or your bill.
The EOB has four sections:
1: Claim Information includes the member and patient name, the member’s group and ID numbers and the claim number.
2: Summary highlights the financial information amount billed, total benefits approved, and the amount you may owe the provider.
3: Service Information identifies the health care facility or physician, dates of service, and charges.
4: Coverage Information shows what was paid to whom, what discounts and deductions apply, and what part of the total expense was not covered.
If something doesn’t look quite right or you have questions about your claim, give us a call at 732-363-3888. We will help you!
Cosmo Insurance Agency is a full-service independent insurance agency based in Hackensack (Bergen County) and Lakewood (Ocean County), New Jersey that offers an all-encompassing range of insurance options for both individuals and businesses. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating our knowledge of the insurance guidelines for healthcare, employee benefits, life insurance, self-insurance, dental, disability, and long term care insurance, we keep our clients up-to-date with affordable plans that cover all their specific insurance needs.
