MailerHouse works with medical or dental care professionals to assist them in sending out their Explanation of Benefits, or EOBstatements.

The Explanation of Benefits typically shows the costs associated with the services you received. The recipient will see what was billed, any discounts, and the proportions of how the payments distributed.

Explanation of Benefits Statements typically contain the following information:

Medical:

  • Contract and member information show member name, address, and who received the services on the EOB. You’ll also see claim group and contract information.
  • Customer service information gives member a toll-free number and address member can use to contact us if the member has any questions about their statement.
  • Claim Summary summarizes any claims received from hospitals, doctors or health care professionals since members last EOB.
  • Summary of Deductibles and Out-of-pocket Maximums shows the member how close they are to meeting their deductible, coinsurance and out-of-pocket maximum for the specified benefit period.
  • Claim Detail has two sections one shows the member what type of care they received, the date of the appointment and the doctor’s name. In the other part, the charges presented for the service; payments already made (by Medicare or another insurer) and details about what the member paid or might have to pay.

Dental:

  • Contract information shows member name, address, and who received the services on the EOB. The group and contract information from the claim are shown.
  • Customer service information gives the member a toll-free phone number and address that can be used as a client service contact if the member has any questions about their statement.

Summary of Services shows the member:

  • What services they or a dependent received during the reporting period, the date of duty, and the dentist’s name.
  • The charge(s) for the service, any discounts the member received, and details about the amount they paid or might have to pay.
  • Other benefit information such as deductible amount remaining, the amount remaining before the member meets their annual benefit max, and benefit coverage percentage.
  • An explanation of why a service may not have been covered.