*This post is the latest in our "Oscar 101" series, where we help you understand how to make the most of your Oscar plan. Read previous entries here (opens in new tab). *
Seeing a medical claim can be stressful. Your first thought is often, “How much do I owe?”
But a health insurance claim isn't actually a bill. It’s a crucial piece of communication between your doctor and your insurance plan. Understanding claims is one of the best ways to manage your healthcare costs and ensure you’re getting the most out of your benefits.
Here is our simple guide to decoding the claims process and how we work together to cover your care.
What exactly is a claim?
At its simplest, a claim is a detailed list of the services you received and what each one costs. When you visit a doctor or hospital, they send this list to us at Oscar.
We review the claim against your specific plan details to determine what services are covered, what discount we have negotiated with that provider, and what amount you may still owe them.
Before you receive a final bill from your doctor, you will receive an "Explanation of Benefits" (EOB) from us summarizing this entire process. (It’s important to remember that the EOB itself is not a bill!)