How to: Read an EOB.

After a wellness exam or surgery, they start showing up in your mailbox—EOBs. Sometimes two or three for the same visit. If you’re like some, you start asking yourself, “What are EOBs? Why do I get them? And what am I supposed to do with them?”

The good news is EOBs are your friend. They’re meant to inform you, not bill you.

First, the most basic question—what is an EOB? Any time you (or your dependents) use the Surest health plan to pay for medical care, you will receive an Explanation of Benefits, often referred to as an EOB.

An EOB is NOT a bill. It’s simply a statement to inform you of how a claim was processed (paid). If a balance is due, you’ll get a bill from the provider.

Why do I get them?

An EOB is generated when your provider submits a claim for the services you received. The EOB provides information about what was covered, how much Surest paid to the provider (doctor, therapist, hospital, etc.), and what you may still owe.

You may receive multiple EOBs from a single visit if more than one service/procedure took place (e.g., an office visit with a physician and lab tests were done).

What do I do with an EOB?

It’s important to look at your EOB to make sure the details align with services you/your dependents received. If the amount you may owe on the EOB doesn’t match what the provider bills you, contact Member Services to determine why. Additionally, you may request a review of the benefit determination (decision about claim coverage) by referencing the appeal rights insert that’s sent with the EOB.

Let’s take a closer look at the details on an EOB.

1. Subscriber, policy, and claim identifiers

2. Breakdown of claim cost

Shows the amount charged by the provider(s), any network discount received, and the payment made by Surest to the provider(s)

3. Your responsibility

The amount you or your dependent(s) may have to pay, based on the price of the procedure(s)/service(s). The amount you owe won’t show any payment you made at the time you received care.

4. Claim details

Date of service: Date the billed service was provided to the member

Provider: Provider(s) who billed for the service

Description: Describes the service or procedure provided

Amount billed: Amount charged by the provider(s)

Amount not owed: Amount discounted from the charged amount based on the provider network used

Surest plan paid: Amount paid by Surest to the provider(s)

Other insurance paid: Amount paid by other insurance plans

Copay: Price of the service/procedure to the member

Non-covered: The charge for a service/expense you/your dependent don’t have coverage for under the Surest health plan

Amount you owe: This total doesn’t reflect any payments/copays you made at the time of service or purchase. Please wait for a provider bill before making a payment.

5. Additional claim information or remarks

Notes providing additional information or remarks about the claim and/or how it was processed