An EOB is a standard document used by health insurance companies (“Insurers”) to communicate with patients. Here is what you need to understand when you get the EOB.

1. 1. The EOB will state the medical services you received and identify the healthcare provider. This is done for their benefit so the Insurers can make sure you received the services the Insurers are being billed for. So far, so good.
   2. The EOB will state the gross charges for these services and how you and your plan will share the payment of those charges under your health insurance plan. If the healthcare provider is in-network with the insurance plan, the charges may already be adjusted to what will actually be owed and paid. In such case, the insurer can use the EOB as a tool showing you the savings you received by going to in-network healthcare facilities. Unfortunately, insurers do not extend this same courtesy to out-of-network healthcare providers.
   3. The EOB is virtually worthless as an explanation if the healthcare provider is out-of-network, as Rice ER is with most plans. The simple reason the EOB is worthless is that insurers send out the EOB before the final amount to be deemed “allowable” and the final amount to be payable on the claim are determined.
   4. Resolving the actual amount to be payable and paid by the insurer is complex and takes months – you will not be billed by Rice ER for any patient portion until the process is complete.
   5. At Rice ER you will never be “balanced billed” for more than what you owe based on (1) an agreed allowable amount (usually comparable to reasonable in-network charges) and (2) the amounts your insurance plan requires as co-insurance, co-pays and deductibles.