Understanding Explanation of Benefits (EOBs) with Sidecar Health
While Explanation of Benefits (EOBs) are available to all members, they are especially beneficial for those who have reimbursement accounts such as HRAs/FSAs/HSAs and those with other insurance plans that coordinate benefits.
What is an EOB?
A statement that summarizes the healthcare costs and insurance coverage provided to you for expenses (claim(s)) submitted to Sidecar Health. An EOB plays a crucial role when seeking reimbursement from third parties such as Health Reimbursement Accounts (HRAs), Flexible Spending Accounts (FSA), Health Savings Accounts (HSAs) and other health plans that coordinate benefits. An EOB is not a bill or invoice.
How to access EOBs, on-demand:
- Visit the “Expenses” page in the member portal and find your expense
- Click "Download Explanation of Benefits"
- Note: EOBs are only available for expenses (claims) that have been fully reviewed and marked as “closed” or those “awaiting payment.” They are not available for open expenses.
All set. Your EOB forms are now ready to be used.
Who uses EOBs:
- Other health plans: When a member has secondary coverage the secondary payer often requires information on the healthcare costs covered by the primary payer to facilitate coordination of benefits.
- Reimbursement account administrators: HRA, FSA, and HSA administrators use EOBs to determine a member’s eligibility for reimbursement.
- Members: Members may be familiar with using EOBs to understand their benefits applied to healthcare service expenses.
- PRO-TIP: In addition to EOBs, Sidecar Health also offers a comprehensive breakdown of each healthcare expense. You can find these summaries by clicking on your expense in the member portal, the same place you will find your EOB download button.
How does my expense detail summary in the member portal differ from an EOB?
At Sidecar Health, we prioritize transparency in healthcare by providing both EOBs and full expense details for all closed claims. Here's a breakdown of the differences:
Expense detail summary in the member portal:
- Provides a comprehensive snapshot of the expense.
- Offers a level of detail specific to our system, not typically found elsewhere in the industry.
- Includes:
- Total amount paid to the provider for each charge
- Total amount applied to your deductible
- Earned benefit credits added to your account
- Final amount Sidecar Health owes you or you owe Sidecar Health
Explanation of Benefits (EOB):
- Shows how much of each provider charge was covered or not covered under your Sidecar Health Plan.
- Will not include account credits earned or used (therefore the total out-of-pocket on your EOB may be different from the total amount owed (or earned) on the expense).
- Is not a bill or invoice.
While EOBs are commonly relied upon for reviewing healthcare expenses, we encourage you to explore your expense detail pages for a more thorough understanding of how your benefits were applied to each healthcare charge, line by line.
More EOB questions? Feel free to contact Member Care at 855-282-0822.