How to Understand an Explanation of Benefits (EOB)

If you’ve ever used insurance to visit a doctor or healthcare provider, you’ve likely come across an Explanation of Benefits (EOB). When you first look at it, an EOB can seem overwhelming. After all, it’s filled with codes, amounts, and insurance terms. But understanding your EOB gives you clarity into what your insurance covers and what you may have to pay for.

In this guide, we’ll walk you through what an EOB is, what’s typically included on it, and why it matters for your hearing care.

An Explanation of Benefits (EOB) is a document you get from your insurance company after you receive care. Despite its name, an EOB is not a bill. Instead, it’s a summary of how your insurance processed the claim from your provider.

Your EOB explains:

• What services you received
• What your provider charged
• What your insurance paid
• What portion (if any) you’re responsible for paying

Let’s say you received a hearing test or were fitted with hearing aids. Your insurance Explanation of Benefits would detail how those services were covered.

Every insurer formats its EOB a little differently, but most include the same sections:

1. Your Information. Your name and ID number.
   
   
2. Your Provider’s Information. The clinic and/or provider who delivered your care.
   
   
3. Reference Number. Otherwise known as a claim number.
   
   
4. Date of Service.  When you received the service.
   
   
5. Description of Service. The type of care provided (such as hearing test, fitting, or adjustment).
   
   
6. Charges Submitted. The total amount your provider billed for their services.
   
   
7. Allowed Charges. How much your provider will be paid for their services.
   
   
8. Amount Paid by Insurer. How much of that amount your plan covers.
   
   
9. Patient Balance. What you most likely owe. This may be in the form of a deductible, co-pay, or coinsurance.
   
   
10. Explanation of Benefits Codes. Sometimes called a “Remark Code.” Short codes or notes that explain adjustments or denials (for example, if a service wasn’t covered). [1]
    
    
11. Additional Information. You may also see a glossary of medical terms, instructions to access the information digitally, and the best way to contact your insurance with questions or concerns.

By reviewing each section, you’ll be able to confirm if your claim was processed correctly and what, if anything, you need to pay.

• Medicare EOB. Medicare beneficiaries may receive a “Medicare Summary Notice” (MSN), which serves the same purpose as an EOB. [2]
  
• Private Insurance EOB. Most health insurance companies provide this information digitally or by mail.
  
• TRICARE Explanation of Benefits. Military families and retirees with TRICARE coverage receive an EOB specific to their plan.

No matter which type of insurance you have, the purpose remains the same: a clear breakdown of coverage and financial responsibility.

It’s a good practice to keep your EOBs for at least one year, or until you’ve confirmed that all claims have been paid and resolved. Some people prefer to keep them longer, especially for services like hearing aids. If you receive care covered from Medicare or TRICARE, keep your EOBs (or Medicare Summary Notices) for at least 24 months.

Insurance paperwork can feel overwhelming. Amplifon Hearing Health Care is a trusted third-party administrator that exists to help you feel empowered and confident about your hearing care. We’re here to make the insurance easier to understand and utilize, so you get the most out of your benefits.