We Explain Tricare's Explanation of Benefits

(Photo: U.S. Army/Marcy Sanchez)
(Photo: U.S. Army/Marcy Sanchez)

If you're like me, you probably wonder just what that document you get from Tricare after you receive any type of medical care actually is. You know, the important-looking one that comes either online or in the mail and says "THIS IS NOT A BILL" on top. Why did I get it and what should I do with it?

That document is known as an Explanation of Benefits (EOB), and it is not a bill. The Tricare EOB is an itemized statement showing what action Tricare has taken on your medical claim.

While insurers, including Tricare, aren't required by law to provide EOBs in most states, many do. This is because it's simply easier for them to do so rather than having to deal with the myriad state laws. Tricare is one of those insurers that sends everyone an EOB.

You may get one each time you get medical care, or you may get it at the end of each month or quarterly, depending on your situation.

You may get your Tricare EOB either online or via mail depending on what plan you have, what type of care you receive and where you get your care.

You will get an EOB for medical care, dental care and pharmacy benefits.

If you receive medical care related to certain sensitive conditions, you won't get an EOB; this is for privacy concerns. Also, if your child is over 18, you won't get an EOB for them. This is the law. By 18, they are considered an adult; any EOB will go directly to them.

What Is Included on a Tricare EOB?

While EOBs are a bit different depending on your specific situation, and they may change over time, most contain the same information:

  • The name of the sponsor and the person receiving care
  • Where the care was provided
  • The date medical care was provided
  • What type of care was provided, sometimes with a standardized medical code number
  • The amount billed
  • The amount covered
  • How much Tricare paid
  • How much was paid by Medicare, or other health insurance
  • Any balance you owe your provider
  • How much has been credited toward your annual deductible and catastrophic cap

What Should You Do with Your Tricare EOB?

It is probably a good idea to at least check out your EOB rather than deleting the email or throwing the letter away. Since almost all EOBs are electronic, you can download them and store them online or on your computer, or you can just access them on the Tricare website whenever you need to.

As a military member or a veteran, hopefully you have learned that sometimes things get lost or messed up by those in charge, and having your own records to back things up is always a good idea.

What Should You Look for on a Tricare EOB?

You always want to check the name, doctor and date of service to make sure everything is correct. Also check:

  • Whether you got the services the provider claims to have performed
  • Whether you are being billed more than once for the same service
  • How much the insurance company paid toward the total bill and whether that matches your plan's benefits
  • Whether you have to pay any or all of the bill because you haven't met your deductible
  • If the insurance company rejected any of the claim and the reason why

Why Is a Tricare EOB Important?

The EOB is your main documentation if you want to file an appeal. If you think you were charged for something that you shouldn't have been, or if a treatment was listed that you didn't receive, your EOB will be the place where you see it first. You may receive bills from a hospital for something that Tricare paid for. If so, your EOB will help you fight the bill collectors.

Bottom line (and good life advice): While it isn't exciting reading, spend at least a couple of minutes checking out anything you get that is related to money or insurance. If you don't, you may find a big surprise or hassle later on that could have been avoided.

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