News | Nov. 16, 2021

Answering Your Questions About TRICARE Explanation of Benefits

By TRICARE Communications

Have you seen your doctor recently? If so, you should have access to an explanation of benefits (EOB). What is an EOB? It’s an itemized statement that shows the action TRICARE has taken on claims filed by you or your provider. An EOB isn’t a bill. But it will identify what health care services you received and how your TRICARE plan will cover the costs.
 
“Anytime you see your doctor, dentist, pharmacist, or you receive care from a hospital, you’ll typically have access to an EOB before receiving the bill,” said Curt Prichard, deputy director of TRICARE Health Plan at the Defense Health Agency. “This document helps you verify that you received the services your provider listed and the amount charged is in line with your plan’s benefits. So, you want to make sure you read through it carefully.”
 
When you see your EOB, you may have questions. We’ve got some answers that may help you understand how EOBs work and what you need to know. First, we’ll start with a look at medical EOBs.
 
Q: How do I read my medical EOB?
A: Your EOB will include important information about the health care service you received. It will have your and your sponsor’s name on it and the provider you received care from. It will also include other details such as:  
Q: How do I access my medical EOB?
A: EOB statements are available online on your TRICARE contactor’s website. To access your EOB, you’ll need to log in or register on their secure portal. For overseas beneficiaries, be sure to use the Beneficiary Secure Claims Portal to access your EOBs. Once you’ve logged in, you can view and print your statement at any time. See information for your region or health plan below:  
Keep in mind, an EOB for claims involving services related to certain sensitive diagnoses aren’t available online and not automatically mailed to you. Your TRICARE contractor can help you learn more about this. Remember, if you only receive care at a military hospital or clinic, you won’t receive an EOB.
 
Q: What should I look for on my medical EOB?
A: Whenever you get an EOB, you should compare it to the bill or statement you received from your doctor’s office. Some of the things you’ll want to check for include:
  • Did you receive the services listed on the EOB?
  • Are you being billed more than once for the same service?
  • How much of your care is covered and what are you expected to pay?
  • Was your claim accepted or denied?
 
After reviewing your EOB, you may be able to appeal certain decisions about your claims.
 
Q: Do TRICARE pharmacy EOBs work the same way as medical?
A: They’re similar. As outlined in the TRICARE Pharmacy Program Handbook, a pharmacy EOB is a statement sent that shows a summary of pharmacy claims that were processed. Each time you fill a prescription at a network pharmacy or through home delivery, Express Scripts records your claim on an EOB. You won’t receive an EOB if you only fill your prescription at a military pharmacy.
 
To view your pharmacy EOB online, log in or register on the Express Scripts website. If you’ve signed up to receive your EOB online, you’ll also get an email once per month that lets you know when you have an updated EOB. If you don’t have a valid email on file or at your request, Express Scripts will mail you a paper EOB. Electronic EOB statements are generated monthly, while paper EOB statements are only provided on a quarterly basis. For more information or to change how you receive your EOB statements, log on to the Express Scripts website or call 1-877-363-1303.
 
Q: What should I know about dental EOBs?
A: Are you enrolled in the TRICARE Dental Program (TDP)? If so, you’ll have access to a Dental Explanation of Benefits (DEOB) from United Concordia Companies, Inc. after seeing your dentist. It explains what was covered and what was paid for your dental services. If there’s an amount you have to pay the dentist, you’ll see it on your DEOB. To view your DEOB online, log in to My Account on the TDP website. You can also choose to receive paperless DEOBs. For more on DEOBs, refer to your TRICARE Dental Program Handbook.
 
Carefully reading your EOB is an important step after receiving care. It helps you understand the services you received, what your TRICARE plan covers, and can protect you from fraud. Have more questions? You can contact your TRICARE contractor and go to TRICARE Forms & Claims to learn more.
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