How to: Read an EOB.

After a wellness exam or surgery, they start showing up in your mailbox—EOBs. 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, an EOB is meant to inform you, not bill you.

First, the most basic question—what is an EOB? Any time you (or your covered dependents) use your Surest health plan, 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. 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.

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 covered 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, if you have questions regarding your appeal rights, please refer to the “Your rights as a member” section of your EOB for details.

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

1. Member, patient and policy identifiers

“Member” refers to the subscriber of the health plan; “patient” refers to the person who received care.

2. Dates of services and summary costs overview

Shows the amount billed by the provider(s), and the total amount you may owe. The amount you owe won’t show any payment you made at the time you received care.

3. Plan balance overview

Shows your out-of-pocket (OOP) limit, progress so far, and remaining amount

4. Claim details

Provider: Provider(s) who billed for the service

Services received: Describes the services or procedure you received

Provider billed: The amount your provider billed your plan for services you received

Amount saved: You do not owe this amount for one of the following reasons: (1) You chose a network provider that gives us a standing discount, (2) You chose an out-of-network provider that agreed to an amount less than billed, (3) It is a surprise bill and the law protects you from having to pay for it.

Your plan paid: The money your health benefit plan paid

Other coverage paid: Amount paid by other carrier

Copay: A fixed amount you pay for a covered health care service, usually when you receive the service or fill a prescription

Plan does not cover: The charge for a service/expense you don’t have coverage for under your Surest plan

Amount you owe: The amount of money you owe out of pocket for the services you receive.