What You Need to Know About Your Explanation of Benefits Statement

Have you ever received a document titled, “This is Not a Bill”? This document is called an Explanation of Benefits (EOB) statement and is provided by your insurance company if you have a Medicare Advantage or Prescription Drug plan. You can expect to get an EOB monthly after receiving any kind of medical service or purchasing prescription drugs.

It's important to keep in mind that an EOB is not a bill you are responsible for paying. It simply outlines how your health plan covers your medical services or prescriptions. EOBs include an itemized list of claims for that month, stating what the charges were, what the insurance company paid, and what your financial responsibility may be. Your provider could write off some or all of the patient cost responsibility. If you do owe money for a service provided, the bill will always come directly from your provider.

What if Medicare is your primary insurance?

When you’re on a Medicare Supplement plan, Medicare is your primary insurance. In this case, Medicare will send you a Medicare Summary Notice (MSN) every three months. This statement is Medicare’s version of an EOB. It provides details about the services and/or supplies billed to Medicare within the previous three-month period and indicates what Medicare covered, along with the maximum amount you could owe the provider. Your insurance company will also send you a separate EOB detailing how it covered your services after Medicare paid its portion of the costs. As with Medicare Advantage and Prescription Drug plans, the provider will bill you directly for any outstanding costs.

EOB & MSN Tips

Below are a few tips from our client advisor team:

• Keep health care-related receipts and bills and compare them to your EOB/MSN statements to ensure all items are accurate. Contact our client advisor team or your insurance company if you have questions or suspect fraud.
• Keep your statements for your records.
• If a medical service or prescription is denied, contact our team and we will help you confirm why it was denied. If a mistake was made, we will guide you through the steps to correct it.
• You may file an appeal if you disagree with a decision.
• Do not make any payments until you receive a bill from your provider.

Questions?

If you’re having trouble deciphering your EOB or MSN or you have any questions related to these statements, schedule a call or reach out to us at 877.222.1942.

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