Have you ever gotten a document from your health insurance company and doctor’s office, but you were confused about what you needed to pay? It might have been an EOB or a medical bill. These two documents are important, but they’re not the same. Let’s break down the differences so you can understand them better. 

What is an EOB? 

EOB stands for Explanation of Benefits. It’s a letter from your health insurance company that tells you: 

• What medical services you received 

• How much the doctor or hospital charged 

• How much your insurance company paid 

• How much you might owe 

Think of it as a detailed summary – not a bill – showing how your insurance processed your claim. It shows how your insurance company handled the costs based on their pre-negotiated rates with the healthcare provider as well as what you might owe based on your specific plan’s coverage, deductible, and out-of-pocket costs. 

Keep in mind that if you have secondary insurance, the amount shown on the EOB will most likely not match the amount owed on the medical bill. You should also receive an EOB from the secondary insurance company. 

What is a Medical Bill? 

A medical bill is a statement from the doctor or medical facility that tells you how much you owe for the services you received. It’s like a receipt for your healthcare visit. 

Medical bills are usually easier to read than EOBs. Here’s what to look for: 

• Your information: Make sure your name and other details are correct. 

• Service details: Check the dates of service and the names of the doctors or hospitals. 

• Charges: See how much the doctor or hospital charged for each service. 

• Payments: Find out if you’ve already made any payments and what the insurance company has paid for. 

• Balance due: This is the amount you still owe. 

It is advised to look at both documents together to ensure that everything is correct and there are no mistakes before paying your bill. 

What to Do if You Find an Error 

If you think there’s a mistake on your EOB or medical bill, don’t worry! Here’s what to do: 

1. Call your insurance company or doctor’s office. Explain the mistake and ask them to fix it. 

1. If your insurance denied a claim in error, you may need to file an appeal 

1. Keep records of your calls and letters. This will help you keep track of the situation. 

1. Don’t pay a bill if you think it’s wrong. Wait until the mistake is fixed. 

Key Takeaways 

• An EOB is from your insurance company, while a medical bill is from your doctor or hospital 

• EOBs show how your insurance company processed your claim, while medical bills show how much you owe 

• Always check both documents carefully for mistakes 

Understanding your EOB and medical bill can help you stay on top of your healthcare costs. If you have any questions, don’t hesitate to ask your insurance company or doctor’s office for help.