Healthcare fraud costs Medicare billions annually, driving up costs for everyone. The good news? You have a powerful tool to help stop it: your Explanation of Benefits (EOB).
What’s an EOB?
Your EOB isn’t a bill—it’s a detailed summary showing how your Medicare Advantage Plan processed recent healthcare services. It includes the date of service, provider name, services received, amount billed, what insurance paid, and your share of costs.
Why Review It? Taking a few minutes to review your EOB can catch problems before they become bigger issues. Unfortunately, many people make critical
Top 3 EOB Mistakes to Avoid
1. Treating It Like Junk Mail The biggest mistake is simply not reading your EOB at all. Many people assume it’s just paperwork or think “the insurance company handled it, so it must be right.” This hands-off approach means fraudulent charges and billing errors go completely unnoticed.
2. Assuming All Charges Are Correct Even when people glance at their EOB, they often don’t question charges that seem “close enough.” They might see a charge for a service they think they received, even if the date is wrong or the provider name is unfamiliar. Small discrepancies can signal bigger problems.
3. Not Taking Action When Something Looks Wrong People often notice something suspicious but don’t follow up, thinking “it’s probably nothing” or feeling intimidated about calling providers. This hesitation allows errors and fraud to continue unchecked.
Red Flags to Watch For
When reviewing your EOB, look for:
- Services listed on days you didn’t visit a provider
- Charges for things you didn’t receive
- Names of doctors you don’t recognize
- More services listed than were actually performed
- Duplicate charges for the same service
- Unfamiliar equipment or tests
What to Do If Something Looks Wrong
- Call the provider first – many issues are simple billing errors
- Contact your insurance company if the provider can’t resolve it
- Report suspected fraud to Medicare at 1-800-MEDICARE or the HHS Office of Inspector General
Your Role Matters
When patients actively review their EOBs, it creates accountability in the healthcare system. Your vigilance helps ensure Medicare resources go toward legitimate care rather than fraudulent claims.
Make It a Habit
Review your EOBs monthly, just like you would bank statements. Keep them organized and accessible. Don’t hesitate to ask questions—no question is too small when it comes to your healthcare benefits.
Remember: Your few minutes of attention each month helps protect both your benefits and the integrity of healthcare for everyone.
Have questions about your EOB? Contact our member services team to better understand your explanation of benefits!
1-800-680-4568 (TTY 711)
October 1st-March 31st: 8AM-8PM local time, 7 days a week
April 1st-September 30th: 8AM-8PM local time, Monday-Friday
eternalHealth is an HMO plan with a Medicare Contract for HMO, HMO-POS and PPO offerings. Enrollment in eternalHealth depends on contract renewal. To enroll in an eternalHealth plan you must meet certain eligibility requirements and reside in the plan’s CMS-approved service area. Benefits and cost sharing may vary by plan.
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