How to read your Oscar Explanation of Benefits | Oscar Rx | hioscar Blog | Oscar
How to read your Oscar Explanation of Benefits
Don’t throw away those EOBs from Oscar! Here’s why (and how) to read them.
Plan Basics Oscar Health Insurance
4 min read
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After every appointment, medical procedure, or lab test, your doctor submits a claim (opens in new tab) to Oscar for the services they provided so they can get paid. Our team processes that claim and pays the doctor according to your insurance plan benefits (opens in new tab).
You might owe money to the doctor as you work toward meeting your plan’s deductible (opens in new tab), we might share the cost, or Oscar might pay for everything. It all depends on your plan and how much you’ve spent on care during the year. We send you an explanation of benefits (EOB) (opens in new tab) in the mail so you can see how all of this breaks down.
If you’re not familiar with EOBs, they can be super confusing. You may wonder: Are they bills? Are they receipts? Am I supposed to keep them? Do I need to share them with my doctor? WTF do they mean?
We get your frustration. It’s why we started Oscar in the first place! Read on to learn more about what EOBs are, how to read them, and why they matter for your wallet.
Contrary to popular belief, EOBs aren’t just complex documents full of codes and costs. Their primary purpose is to communicate that Oscar received a claim from your doctor, and who owes what for your medical services.
Good EOBs clearly communicate how you got care, who gave it, what services you received, and how you were diagnosed. They’re the fastest way to verify that your bill is correct. They also provide a level of transparency into the healthcare system—you can see exactly what your doctor charged for, the rates Oscar negotiated with them, and what Oscar paid on your behalf.
How to get your EOBs
Oscar sends a copy of every EOB to you in the mail. If you've been to the doctor a lot, your EOBs will be sent in batches so your mailbox doesn't get flooded with individual letters.
You can also view your EOBs in the timeline portion of your Health Profile (opens in new tab) at hioscar.com or in the Oscar app. The online versions of your EOBs include additional details about the services you received.
EOBs are federally mandated, which means that most of the information they contain is required by law. They’ll always contain the following set of codes that give a snapshot of an exact moment you receive care:
Facility’s Tax ID number: Where the care was administered.
Provider’s NPI number: Who administered the care.
ICD-10 diagnosis code: Which conditions were treated.
CPT code: What type of care was administered or procedure was performed.
Processing codes: How care was processed, if it was denied, and what type of information is needed in order to reprocess.
This information is often presented in scary, number-filled grids, but we’ve designed our EOB to be easier to read.
While it’s tempting to throw away your EOBs after a quick glance, they’re actually worth a closer look. They provide an opportunity for you to confirm that your doctor, medical facility, and the services coded on the EOB match what you experienced in person. Just like you glance over your credit card bill to make sure you weren’t charged for fraudulent activity, you should look over your EOB.
If there’s a discrepancy, it’s important to call or message your Concierge team immediately to resolve the issue. In fact, it’s one of the top reasons members contact Oscar for help! Your care guides can explain any points of confusion around how your benefits were applied and any bills you should expect from your doctor. They can also look into any line items that seem incorrect or duplicative.
Questions to ask your doctor during your visit
The best way to catch issues with an EOB is to understand the care you received when you saw the doctor. Here are a few questions you can ask during every appointment to make sure you know exactly what the doctor will be submitting claims for (and consequently, what you might end up getting billed for later).
What is the medical diagnosis for my condition?
What services (tests, scans, procedures, etc.) are you providing today?
What equipment are you using, and for what purpose?
What lab are you sending my samples to for testing? (Quest Diagnostics is Oscar’s preferred lab, so it’s important to confirm that labs are sent there or to another lab in our network. Labs sent out of network may be expensive and won’t be covered by your plan.)
Proactively asking questions and gathering information during your doctor’s visit might feel awkward at first, but you deserve to understand what’s going on with your health and the care you’re receiving. Especially if you have a deductible, you need to understand how your doctor’s decisions impact your finances. With a clear understanding of your care, you can help spot mistakes on your EOBs and keep unnecessary bills out of your mailbox.
You don’t have to do this alone. If you have EOB-related questions or want someone to review your EOB with you, call your Concierge team at 855-672-2755 or message them at hioscar.com (opens in new tab) and through the Oscar app. We’re here to help!
