How to Read a TRICARE Overseas EOB

After TRICARE processes your claim, it sends an explanation of benefits (EOB). TRICARE is clear that an EOB is not a bill: it is an itemized statement that shows what action TRICARE has taken on your claims. It is the one document that tells you what actually happened, so keep it with your insurance records and read it line by line.

An example, with the parts to look at

Layouts differ, and an overseas EOB is often a series of claim blocks, one for each claim or provider. Here is a made-up example of one block.

An example EOB made up for this guide. The numbers are invented and real layouts vary.

1. Claim number. The number assigned to this claim. Write it down: you will need it when you ask about the claim.
2. Provider. Who treated you, as TRICARE has it.
3. Amount billed. What the provider charged.
4. Amount allowed. What TRICARE recognizes as the allowed amount for the service. This is why the amount paid can be lower than the amount billed.
5. TRICARE paid. What TRICARE paid on the claim.
6. Amount you owe. What the EOB says is your responsibility, which can include cost share and deductibles.
7. Cap met to date. A running total toward a yearly limit on what you pay. It is a total so far, not a new charge for this claim.
8. The appeal notice. If the EOB tells you how long you have to appeal, use the date it prints.

Other lines you may see are the date the claim was processed (some overseas EOBs leave the date of service blank) and other insurance paid, which shows what another insurer paid first. TRICARE is always the last payer.

What to check first

1. Is it the right person and provider? A wrong name or provider is worth reporting.
2. Does the claim number match the claim you filed?
3. Is a service denied, or paid at $0? If so, look for the printed reason. That reason is what you respond to.
4. Is the other insurance counted? If you have other coverage, its payment should show.
5. Which currency are the amounts in? An EOB can say all amounts are in U.S. dollars even if your bill was in euros. Do not expect the numbers to match your bill one to one. See claims in foreign currency.
6. Is there a denial? If you disagree, note the date on the notice.

If you disagree: the 90-day window

TRICARE says you can appeal certain decisions about your claims, and that you should file an appeal within 90 days of the date of the EOB notice. Put that date in your calendar the day the EOB arrives. TRICARE also publishes a guide called “What Is an Explanation of Benefits (EOB)?” that explains the denial codes. Our guide to fixing a rejected claim covers the usual causes.

If something looks wrong

Compare the EOB with your bill, then contact your TRICARE Overseas regional call center, or use secure messaging in the claims portal, and give them the claim number.

Keep it, and go paperless if you like

You can view your EOBs online in the secure claims portal and request paperless EOBs there. Keep a copy anyway. EOBs are useful later for your own records, at tax time and as proof for other insurers.

How PaidTrail reads EOBs

When you add an EOB, PaidTrail reads each claim block and shows every figure next to the exact words it came from, so you can check it against the document. It never estimates what TRICARE will pay: every number comes from an EOB you added and confirmed. It also shows what is waiting for an EOB, keeps the appeal date only when the EOB states one, and reminds you when a claim has been outstanding for a while.