Tips for Using Your Health Insurance EOB

by Jamie Simmerman · 4 comments

As part of the U.S’s Health Insurance Portability and Accountability Act of 1996 (HIPAA), health insurance companies now submit a standardized form for all medical services and products billed under a health plan. This form is called an Estimation of Benefits (EOB), or less commonly a Remittance Advice (RA; these are the EOBs sent to your physician’s office) or Explanation of Medicare Benefits (EMOB). Your Estimation of Benefits is the primary tool for tracking and disputing what is paid out-of-pocket for your medical care. Trusting that your insurance company is billing accurately is a mistake that can cost you money. Billing errors and miscommunication regarding your medical care are common, and can adversely affect how much you are deemed responsible to pay.

Understanding the Basics

The first step in checking that your insurance company and medical providers are billing you properly is knowing the details of your insurance plan. Important info to look up includes:

  • Copay amounts for different types of services (Urgent Care, physician’s office, outpatient services)
  • Which facilities and medical providers are considered in network for your health plan
  • What portion of services your insurance plan pays- usually expressed as a percentage
  • Any excluded or non-covered services or medical items
  • Expected amount of coinsurance payments
  • The listed maximum out-of-pocket limit

Once you know how your insurance plan works and what is and isn’t covered, you’re ready to start looking at your Estimation of Benefits files. You should keep these files for a minimum of five years, in case there is ever a dispute about services rendered or paid to a provider.

Tips for Using Your EOB
Your EOB sheet provides vital information about what the insurance company’s records show regarding any healthcare services rendered to a party listed under your health insurance ID number.

Here, you can find the name of the patient, the date of service, the healthcare provider requesting payment, and your insurance company’s plan to pay a portion or all of the submitted charges. You will also find special codes that provide ID numbers for the patient and provider, reasons for denial of a payment, and diagnosis or service codes submitted on your behalf by the physician (CPT codes, or CPT modifiers).

One of the best ways to track this information, especially if you visit the doctor often, is to scan the EOB and feed the info into a spreadsheet. This method allows you to sort the info by date of service, provider, or any other parameter listed on the EOB. This also makes submitting your out of pocket medical costs for tax purposes much easier at the end of the year. However, this method can be laborious at times and is not for everyone.

For those who prefer a simpler method of tracking, you can keep two files. One filled with original EOBs sorted by date received, and a second working file filled with copies of each EOB sorted in any manner that works for you. On the copied EOB pages, you can highlight important info or suspicious charges, and make notes of any contact with your medical provider or insurance company. Be sure to list the date and time of the contact, the first and last name of the person you spoke with, and full details of what was discussed. Having exact details when disputing a charge will go a long ways toward getting the issue straightened out with the least amount of hassle.

If you have an EOB tracking or filing system that is working for you, we want to hear about it! Your system can help others become more efficient in tracking healthcare charges. Feel free to share your tips in the comments section below.

Next week, we’ll cover how to read the information on your EOB, including how to make sense of all those codes.

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  • Jerry says:

    I used to work for a chiropractor and had to deal with the insurance company regularly and the billing process can be a nightmare. You really need to look at your paperwork and policy carefully otherwise it can lead to a lot of problems and most likely a lack of coverage for your services.

  • Beth Morgan says:

    Jamie– have you heard about my site, Simplee ( It helps people automatically track and manage their EOB and medical bill info. Once you create a free account and enter the log-in info for your health insurance, dental insurance, etc, it brings over the data and summarizes everything in a dashboard so you can track spending, deductibles, etc. It also explains each claim in a plain, easy language, which is kind of a miracle. And you can pay the bill, too! Hope you’ll check it out and tell us what you think.

    • Thad P says:

      Beth, Simplee is a great site. We are excited about the service you guys offer. Another option, if looking for a personal adviser to work through an EOB is (full disclosure: I work there).

  • Thad P says:

    Excellent advice. I recall when my father passed away many years ago I was astounded at the amount of paperwork related to medical incidents and expenses that he had kept. It is really an overwhelming amount in most instances.

    Re: keeping the EOBs, I concur. It pays to keep them, and can pay even more if we understand what they say and/or mean. There are advocates who can assist in that regard.

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