EOB (Explanation of Benefits)

Extended Definition

An Explanation of Benefits (EOB) is a document your insurance sends after processing a medical claim. It breaks down what the provider charged, what insurance paid, and what you’re responsible for paying.

Reading Your EOB

Key sections include:

Section	What It Shows
Provider/Service	Who provided care and what service
Date of Service	When you received care
Amount Billed	What provider charged
Allowed Amount	What insurance approves for the service
Insurance Paid	What insurance paid to provider
Your Responsibility	What you owe (deductible, coinsurance, etc.)
Claim Status	Approved, denied, or pending

EOB vs. Bill

Important distinction:

• EOB = Informational document from insurance
• Bill = Payment request from provider

Wait for actual bill before paying. The EOB tells you what to expect, but the provider bill is what you pay.

Common EOB Terms

• Allowed amount: Maximum insurance will pay for service
• Adjustment: Difference between billed and allowed (you don’t pay this)
• Applied to deductible: Amount counting toward your deductible
• Not covered: Service insurance won’t pay for
• Patient responsibility: What you owe

What to Check on Your EOB

1. Correct services listed - Match your records
2. Dates are accurate - When you received care
3. Amounts make sense - No obvious errors
4. Denial reasons - Understand why if denied
5. Your share - Matches what you expected

If Something Looks Wrong

• Contact insurance - Ask about discrepancies
• Contact provider - Verify billing accuracy
• File appeal - If you disagree with decision
• Keep records - Save EOBs for your files

Medicare EOBs

Medicare sends a “Medicare Summary Notice” (MSN):

• Mailed quarterly
• Also available online at Medicare.gov
• Shows all claims for the period
• Review carefully for errors or fraud