After each session, your insurance provider may send you an Explanation of Benefits (EOB). While it might look like a bill, it’s not a bill. Instead, it outlines important details about the costs associated with your care.
This guide will help you understand the purpose of an EOB, how to read it, and what it means for your out-of-pocket expenses.
Key Takeaways
An EOB is not a bill; it outlines the services received and costs.
EOBs help you verify services and costs and spot potential errors.
You should check your EOB for accuracy and save it for future reference.
Grow Therapy charge rates listed on the EOB are not the actual amount you owe; your share is typically a copay, coinsurance, or deductible.
Frequently asked questions
What is an EOB?
An EOB is a statement from your health insurance company that explains how they processed a claim for services you received. It’s designed to provide insight into:
The total cost of the care you received.
The amount your insurance plan covers.
The amount you may owe after insurance payment.
✅ Why are EOBs important? EOBs serve several important purposes, including:
Verification: You can confirm that the services listed were actually provided and that the charges are accurate.
Cost clarification: It helps you understand how much of the cost was covered by your insurance and how much remains your responsibility.
Error detection: By reviewing your EOB, you can identify any mistakes in billing or personal information so they can be corrected promptly.
Financial planning: It helps you calculate how much you might need to set aside for upcoming costs, like copays or deductible payments.
How is a claim processed?
After each session, a claim is sent to your insurance provider for processing, which results in an EOB issuance. Here's what the process looks like:
Claim submission: Grow Therapy submits a claim with a charge rate (usually between $180 and $350).
Insurance processing: Your insurance company reviews the claim and determines how much it will cover. This process usually takes about 3–4 weeks.
EOB issued: Once the claim is processed, both you and Grow Therapy will receive an Explanation of Benefits (EOB) outlining the amount you may owe.
🧾 Example: If your session was billed at $162 and your insurance covers $122, you would be responsible for the remaining $40 (your copay, coinsurance, or deductible). Grow Therapy will then charge this amount to the card you have on file.
This guide has more details about insurance coverage and how claims are handled.
How do I read my EOB?
Receiving EOBs can feel overwhelming, but understanding the sections can make things clearer. Here’s a breakdown of what you’ll typically find:
Patient information: This section confirms that the services listed are for you.
Provider information: This section identifies the healthcare provider or facility that provided the service, such as Grow Therapy or your therapist’s office.
Service description: This section outlines the services you received (e.g., a therapy session, screenings, etc.), along with any relevant codes associated with those services.
Provider charge(s): This is the amount billed by the provider for your session or service. This charge is typically the highest number you’ll see in your EOB. However, remember that this is not the amount you will owe!
Allowed charge(s) member rate: This is the negotiated rate between your insurance company and the provider. It’s typically lower than the billed amount and is used to determine how much your insurance will pay.
Plan's share: This shows the amount your insurance will cover. This amount is paid directly to the provider and reduces your out-of-pocket costs.
Your share: This is the amount you owe after your insurance has paid its share. This may include your copay, coinsurance, or part of your deductible. If you’ve already made a payment to the provider, it may not yet appear on this EOB.
Amount not covered: This section includes the portion of the charge not paid by insurance. This could be due to deductibles, copays, coinsurance, or services not covered under your plan.
Remark code: Remark codes provide explanations for certain charges, such as why a service wasn’t covered (e.g., “not medically necessary” or “out-of-network service”).
💰Why is the billed (provider charges) amount so large? It’s common to see a high billed amount on your EOB—but don’t panic! That’s not the amount you owe.
The billed amount: This is the full price that Grow Therapy charged for your services.
What you owe: After your insurance processes the claim, you’ll only be responsible for "your share" amount, which could be your copay, coinsurance, or portion of your deductible.
What do I do with my EOB?
After receiving an EOB, you should:
Double-check the information: Verify that all details are correct, including your name, the services listed, and the associated charges.
Contact insurance for clarification: Request more details if something seems incorrect, such as unfamiliar charges or inaccurate coverage.
File or save it: EOBs are important records. Keep them for future reference, or if you need to follow up with your insurance company or provider.
How much do I owe?
Once your insurance company processes the claim, your EOB will show the amount you're responsible for. You may be charged for any of the following:
Copay: A fixed amount you pay for each session.
Coinsurance: A percentage of the total cost that you are responsible for.
Deductible: The amount you must pay out-of-pocket before your insurance begins to cover costs. Once your deductible is met, you’ll typically only pay a copay or coinsurance until you reach your out-of-pocket maximum.
This video by Kaiser gives a great overview. Remember that if you have a deductible-based plan that restarts at the beginning of the year, you may be charged the full member rate until you reach your deductible.