How to Get the Most from Your Explanation of Benefits Statement

Explanation of Benefits

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

It is important to remember that an EOB is not a bill you are responsible for paying. EOBs break down the way your medical service is covered by your health plan. They include an itemized list of claims stating what the charges were, what the insurance company paid and what your patient responsibility may be. Sometimes your provider may write off some or all the patient responsibility. If you do owe money for a service provided, the bill will always come from your provider.

Explanation of Benefits - doctor visit

If Medicare is Your Primary Insurance

When Medicare is your primary insurance, 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. If you are also on a Medicare Supplement plan, your insurance company will send you a separate EOB detailing how it covered your services after Medicare paid its portion of the costs.

Explanation of Benefits Tips from Our Team:

  • Keep your EOB and/or MSN statements for your records.
  • Keep health care-related receipts and bills and compare them to your EOB/MSN statements to ensure all items are accurate.
  • If a service is denied, contact your insurance company to confirm why they denied the claim. If the provider’s office made a mistake when they submitted documentation, you can contact them and request that they re-submit the claim to the insurance company.
  • You may file an appeal if you disagree with a decision.
  • Contact your insurance company if you have questions or suspect fraud.
  • Do not make any payments until you receive a bill from your provider.

Have Questions?

If you’ve contacted your insurance company and are still having trouble deciphering your EOB or MSN, you may contact us at 1-877-222-1942 or for assistance!

If you are not a RetireMEDiQ client and have questions about how we can help you, please contact us at 1-866-600-5638 or to get started on your Medicare journey.

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