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Report: Most health plan EOBs are confusing
By Insure.com staff

Two-thirds of Explanation of Benefit (EOB) statements from health insurance companies are confusing, according to a new report from Dalbar Inc., a research firm in Boston.

The EOB is one of the most important communications a health plan member receives from the insurer, and it's also one of the least understood documents, filled with codes and jargon.

In its fifth annual "Trends and Best Practices in Explanation of Benefit Statements" report, Dalbar highlighted three providers that do a good job in explaining what plan members must pay based on their benefits and coverage. According to Dalbar:

  • BlueAdvantage Administrators of Arkansas provides the best benefits summary with clear explanations of insurance terms and their implications along with helpful charts.
  • Cigna provides an educational claims summary table that defines each line item.
  • Wellpoint provides a helpful cover page that explains what the EOB is and what the member should do with it, rather than using the traditional approach of simply stating, "This is NOT a bill."

"An EOB designed to provide understanding at the deepest level to serve the most inquisitive members will be the EOB that serves all members," Dalbar Managing Director Kathleen Whalen said in a press statement.

Dalbar evaluated the EOBs using a method developed and refined over the last 20 years of evaluating print and electronic communication. EOBs earned credit for including helpful design elements and features that answer consumers' questions and clearly explain the significance of the information.

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