Reading My Explanation of Benefits

After your hospital visit you will receive many different medical bills from your providers and an explanation of benefits from your insurance company.  It is important to review and keep these documents.  Below are some tips that will help you better understand how to determine what you owe:

1. Read each bill and explanation of benefits carefully.  If you have any questions, call the customer service number on the bill and/or explanation of benefits.

2. Separate your bills from your explanation of benefits.

  • Make a separate stack for each hospital, doctor, or insurance company.

3. Match the hospital and doctor bills to their corresponding explanation of benefits.

  • Take one of your hospital or doctor bills and find the date of service and the amount of the charges.
  • Then, look through your explanation of benefits and find the one or ones if you have multiple insurances that have a matching service date and charge amount.
  • Clip them together.

4. You will need to determine if the bill is paid in full or if there is a balance due.

  • The explanation of benefits will tell you if the charge was paid by your insurance provider; how much they paid; if the charge was denied or is pending; and what amount was applied to your deductible and/or co-insurance.
  • The explanation of benefits will also tell you if your insurance company needs additional information such as accident details to finish processing your claim.

5. Is the bill paid in full?  If yes, file it away in a folder or pocket of an accordion folder labeled "Paid In Full." 

6. If the bill is not paid in full and the bill is awaiting insurance payment, file it in a folder or pocket of an accordion folder labeled "Needs Payment from Insurance Company."  Follow-up with your insurance company on these balances and provide any additional information that is needed to process your claim.

7. If the bill is not paid in full and the bill is awaiting payment from you, file it in a folder or pocket of an accordion folder labeled "Needs Payment from Me."  These are the balances you need to pay the provider.

  • When payment has been made, move the bill to the "Paid In Full" pocket or folder.

8. Remember to call your insurance company if they do not pay your claim within 30 days from the date you received services.

9. Follow these same steps to match the rest of your hospital and doctor bills.