How to read your Explanation of Benefits

An Explanation of Benefits (EOB) is a statement that shows the health care services you received, what Aetna® pays and the amount you may owe once you are billed.

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There are several resources to help you know what services and costs you had for a doctor's visit or medical treatment. The Explanation of Benefits (EOB) document is one of those resources. Keep reading for tips on how to understand your covered services and costs.

What’s an Explanation of Benefits?

Your Explanation of Benefits (EOB) explains what portion of services were paid by your plan and what part you may be responsible for paying.

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Have you visited your plan web page?

It has details about your personal coverage and how to make the most of your plan. You can find the website on your Aetna Member ID card.

An EOB is not a bill. It's a summary of medical services you received and how your Aetna® plan benefits are applied to those services. It shows charges, payments and potential balances you may owe, depending on services and treatment you received.

Your EOB includes:

The date of your service
The amount your provider billed Aetna
The amount your Aetna Medicare Advantage plan approved
The amount Aetna pays
The remaining portion you may owe — either as a copay (usually paid at the time of your visit) or as coinsurance (your share of the cost)

If you owe an amount after your plan pays your provider, you'll receive a bill from your provider. It will be for any charges that you're responsible for paying.

An EOB will also include a general overview of certain best practices. This may include general guidelines for identifying insurance fraud, the importance of preventive care or additional Medicare resources available to you as a member.

Many plans now have a new feature allowing you to access a detailed breakdown of your EOB online. Keep reading to see how to access your EOB using your secure member website.

Check your benefits. Go to your secure member website at AetnaMedicare.com/Login to register or log in.

How do I view my EOB?

There are two ways to get your EOB. You can receive a paper copy by mail. Or you can view it online.

You can also request to receive an email notification once your EOB is available. You can then view it online at your convenience. For help with finding out which delivery method you selected, call us at 1-833-570-6670 (TTY: 711), 8 AM to 8 PM, 7 days a week. We'll be happy to help you.

To view your EOB online, register or log in to your secure member website. From there go to the “Claims” tab, then choose “Explanation of Benefits.” Your medical information remains secure online.

With paperless EOBs, there’s no need to shred any documents. You’ll have up to24 months of statements organized by month and year online. That’s two years of statements at your fingertips. If you want to start receiving paper statements, you can opt out of electronic delivery at any time.

Here’s an example of EOB details from Medicare Advantage plan member Linda.*

Linda’s EOB includes:

The date of her appointment and services received
The amount her provider billed Aetna® for their services
The amount her Aetna plan approved
The amount Aetna pays for her services
The amount she may owe

It’s unlikely to happen, but if the details of the services she received don’t match what her EOB states, Linda can call Aetna Member Services at 1-833-570-6670 (TTY: 711), 8 AM to 8 PM, 7 days a week. They will answer her questions and help resolve the issue.

*Linda is not an actual member. This is for illustrative purposes only and does not reflect an actual member outcome. Your actual EOB may look different based on your plan, services and costs.

Check your coverage

An EOB helps to make sure you've been billed correctly for services and that you received the services it shows. That way, you can keep track of what your plan is being charged, and what you are responsible for paying.

You should always look through your EOB and confirm your:

Member ID number
Provider office or hospital
Date of service
Prescription information (if applicable)
Share of the cost

If you think you were charged for tests or services your plan was supposed to pay, or any information on your EOB doesn't look correct, call Member Services at 1-833-570-6670 (TTY: 711), 8 AM to 8 PM, 7 days a week. We'll be happy to help you.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. The formulary, provider and/or pharmacy network may change at any time. You will receive notice when necessary. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.