Bills and insurance
Explanation of Benefits (EOB) explainer
An EOB is your insurer's account of how a claim was processed, laid out in columns that rarely add up at first glance. Add yours below to see each service on its own row with every amount explained.
Explain your Explanation of Benefits (EOB)
- 1. Add itDrop a PDF, take a photo or paste the text.
- 2. Check itPersonal details are removed on your device. You approve what is sent.
- 3. Read itSummary, table of results, terms and questions to ask.
The explainer opens on its own page with no adverts and no outside scripts. Your file is read on your device and is never uploaded.
What you get
- Each service line with billed, allowed, paid and owed amounts as printed.
- Plain definitions of allowed amount, deductible, copay and coinsurance.
- Remark or reason codes restated using the wording on your statement.
- Questions to ask your insurer or the provider's billing office.
Columns you will usually see
- Amount billedWhat the provider charged
- Allowed amountThe price your plan accepts for that service
- Plan paidWhat the insurer paid the provider
- DeductibleThe part that counts toward the amount you pay before the plan starts paying
- Copay and coinsuranceYour fixed fee or percentage share
- What you owe or patient responsibilityThe insurer's figure for your share
What this tool cannot tell you
An EOB is not a bill. The amount it shows as your share should match the bill you later get from the provider, and comparing the two is the best check. MedicDecode cannot see your policy, so it cannot say whether a claim was processed correctly. It does not give legal or financial advice.
Common questions
Do I pay the amount on the EOB?
Not to the insurer. The EOB tells you what the provider may bill you. Wait for the provider's bill and check that the amounts agree.
What is the allowed amount?
The most your plan will recognise for a service. For in-network providers the difference between the billed and allowed amounts is normally written off.
What are remark codes?
Short codes that explain why a line was paid, reduced or denied. Their meanings are usually listed at the foot of the statement.
Words you may see on this report
Tap a word for its plain-English meaning, an example line and what it does not mean.
- Coinsurance
Coinsurance is the percentage of a covered health care cost you pay after meeting your deductible, such as 20 percent of the allowed amount.
- Deductible
A deductible is the amount you pay for covered health care each year before your insurance starts paying its share.
- Explanation of Benefits (EOB)
An explanation of benefits (EOB) is a statement from your insurer showing what was billed, what the plan paid and what you may owe for a claim.
- Out-of-Pocket Maximum
The out-of-pocket maximum is the most you pay for covered, in-network care in a plan year; after that, the plan pays 100 percent of covered services.
- Copay
A copay is a fixed amount you pay for a covered health service or prescription, such as a set fee for each doctor visit.
- CPT Code
A CPT code is a five-character code that describes a medical service or procedure, used on bills and insurance claims in the United States.
- ICD-10 Code
An ICD-10 code is a letter-and-number code that describes a diagnosis, symptom or reason for care on medical records and bills.
- In-Network
In-network means a doctor, hospital or pharmacy has a contract with your insurance plan to provide care at agreed prices.
- Prior Authorization
Prior authorization is approval your insurer must give before certain treatments, tests or medicines are covered.