EOB meaning: what an Explanation of Benefits is
EOB stands for Explanation of Benefits. It's the summary your health insurer sends after it processes a claim. Here's what it tells you and how to use it.
Your EOB is generally not a bill
An EOB comes from your insurance company, not the provider. It explains how a claim was processed: what was charged, what your plan allowed, what the plan paid, and what it says is left for you.
Because it is a summary and not a request for payment, an EOB usually says something like 'this is not a bill' somewhere on the page.
The words on your EOB
- • Allowed amount: the price your plan and the provider have agreed on. Your share is usually calculated from this number, not from the higher original charge.
- • Deductible: the amount you pay yourself before your plan starts sharing costs.
- • Copay: a fixed amount for a particular visit or service, such as $30 to see a doctor.
- • Coinsurance: a percentage of the allowed amount that you pay after the deductible, such as 20%.
- • Out-of-pocket maximum: the most you would pay in a plan year for covered services. Your own plan documents have the exact figures.
What to do with your EOB
The most useful thing you can do with an EOB is compare its 'patient responsibility' with the balance on the provider's statement. When the two differ, that is a good reason to call both.
Keep every statement. Balances change as insurance processes the claim, and having the earlier version makes questions much easier to ask.
If you appeal, use the instructions, addresses and timeframes printed on your own documents. Attach the EOB, the bill and the denial letter, and keep copies of everything you send.
Have a bill and an EOB that don't match?
Upload both and the Detective will compare them line by line and explain any potential discrepancies in plain English.
Compare my bill and EOBImportant: The Medical Bill Detective provides informational assistance based on the documents you provide. It does not provide medical, legal, insurance, or financial advice and does not determine whether a bill is legally valid, fraudulent, or incorrect. Potential discrepancies should be verified with your healthcare provider and/or insurance company.