Why Is It Important to Review Your Explanation of Benefits 

An explanation of benefits, often called an EOB, is a statement your health insurer sends after you receive medical care. It outlines the services billed, what your plan paid and what portion you may owe. An EOB is not a bill, but it explains how your claim was processed and how your benefits applied to that visit.

Why Reviewing Your EOB Matters

Reviewing your EOB is essential for a number of reasons:

• Identifying errors—Mistakes can happen in billing or claim processing. Reviewing your EOB can help you catch errors, such as being charged for services you didn’t receive or incorrect billing codes.
• Understanding coverage—Services like counseling, chiropractic care and medical spa treatments may only be covered if they are considered medically necessary. Your EOB will clarify what was covered and why.
• Preventing surprises—Your EOB shows how deductibles, copayments and coinsurance apply to each claim. This allows you to track your out-of-pocket costs throughout the year and see if you’re responsible for any out-of-pocket costs before a bill arrives.
• Detecting fraud —Reviewing your statements can help you spot unauthorized or fraudulent claims made in your name.

Are Counseling, Chiropractic Care and Med Spa Covered?

Counseling, chiropractic care and medical spa services can be covered by health insurance, but the extent of coverage often varies by plan. In most cases, insurers only pay for services they consider medically necessary. This generally means the treatment is required to diagnose or treat a documented illness or injury and meets accepted clinical standards. Services provided for general wellness, maintenance care or cosmetic purposes are usually excluded. Before scheduling treatment, review your plan documents or contact your insurer to confirm what is covered, any visit limits and your expected out-of-pocket costs.

Contact Us

If you have questions about employee benefits or want to review your current group health coverage, reach out to Swift Kennedy & Associates, Inc.. We work with Pennsylvania businesses to evaluate plan options, explain coverage details and help employees understand how their employee benefits function in real-world situations. Contact us today to get started.

This blog is intended for informational and educational use only. It is not exhaustive and should not be construed as legal advice. Please contact your insurance professional for further information.