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Health Care Reform:

Health Insurance & Affordable Care Act

Your Guide to Health Insurance Paperwork


4. What is a uniform glossary of terms?

The glossary defines some of the most commonly used insurance terms in plain language. These terms include co-insurance, balance billing, appeal, and medically necessary. Your plan will have its own glossary, but you can see an example here.

5. What is an EOB?

Your insurance company sends you an explanation of benefits when it gets a request for payment from one of your health care providers (such as doctors, specialists, laboratories, hospitals, and clinics). The EOB describes the medical treatment you got from the provider. Note: Some HMOs do not provide an EOB because they pay their providers a monthly fixed fee for your care.

6. Why is an EOB important?

This statement is your chance to review the money that's being paid for your health care. By checking your EOB, you can track how much your health care costs. You also can look for billing errors. EOBs give you the chance to question any payment that doesn't look right.

7. What information is on an EOB?

It should show:

  • Your name and address
  • Your policy number
  • The name of the patient -- you or the person who got treatment
  • The name of the doctor who provided the care
  • The date of the service
  • The fee that you were charged for treatment
  • How much your insurance paid
  • How much you owe for this visit

Your EOB also should have a short description of the care the patient got. If part of the care was not covered by your insurance, the EOB will explain why.

8. What should you check on every EOB?

  • Whether you saw the doctor on the date listed
  • Whether you got the services the provider claims to have performed
  • Whether you are being billed more than once for the same service
  • How much the insurance company paid toward the total bill and whether that matches your plan's benefits
  • Whether you have to pay any or all of the bill because you haven't met your deductible
  • If the insurance company rejected any of the claim and the reason why

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