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Ashford Insurance

How to read your UnitedHealthcare® Explanation of Benefits (EOB)

Sarah Fuhrmann

Sarah Fuhrmann

Sarah Fuhrmann is an agent of Ashford Insurance an independent health insurance agency specializing in Texas Medicare insurance.

Every month after UnitedHealthcare® processes claims received from your provider (or receive claims from your pharmacy), we’ll send you a cost summary — it’s called an Explanation of Benefits, or EOB.

UnitedHealthcare® Explanation of Benefits

Every month after UnitedHealthcare® processes claims received from your provider (or receive claims from your pharmacy), we’ll send you a cost summary — it’s called an Explanation of Benefits, or EOB. It shows what the plan paid and how much you’ve paid (or will be billed by your provider). You will only get an EOB in months after a claim has been processed. For example, if your doctor or pharmacy sends us a claim in June, you’ll get an EOB in July. Your EOB is not a bill.

Here are the different parts of your EOB:

 

Cost summary total chart 

You’ll find this chart on page 2 of your EOB. It shows the month and year-to-date totals of what your provider billed for services. Your share is the amount you may owe (such as copay, coinsurance deductible, denied claims). If you owe anything, your provider will send you a bill.

Member Cost Summary

Out-of-pocket maximum cost chart

This chart starts on page 3. It shows the most money you will have to pay for covered services in a plan year.

Member Out of Pocket

Monthly claim details

These are the details of the claims that make up your monthly total. It is usually the same total for the month listed in the cost summary above, but this chart lists each claim processed by provider and date. We’ve included notes with more information about your claims.

Member Monthly Claim Details

If you have an optional supplemental dental rider, your EOB will have a separate chart with dental claim details.

Remember, your EOB is not a bill.

It is simply a statement of services you received with details on how you and your plan will share the costs. To make sure your provider is billing you correctly, you should always compare your EOB to bills you receive from your provider.

 

Note: These charts are used for example only and may not look exactly the same as the charts included in your EOB.

 

Photo by Marcus Aurelius from Pexels

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Sarah Fuhrmann

Sarah Fuhrmann

Sarah Fuhrmann has been helping Medicare eligibles in Texas with their Medicare Insurance since 2018.