Bills and insurance
What Is an Explanation of Benefits (EOB)?
Explanation of Benefits (EOB) · say it: eks-pluh-NAY-shun ov BEN-uh-fitsAlso written: EOB, explanation of benefits statement, claim summary
Short answer
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.
What it means
After you receive care, the provider sends a claim to your insurer. The insurer then sends you an EOB that breaks down the claim: the amount billed, the allowed amount, what the plan paid, and your share through the deductible, copay or coinsurance.
An EOB is not a bill. The bill, if any, comes from the provider. Comparing the two helps you check that you are being charged the right amount.
EOBs often include codes for services and diagnoses, and remark codes explaining any denials or adjustments. Most insurers explain these on the back of the statement or online.
Where you may see it
- Mail or email from your insurer
- Insurance member portals
- Records you compare with medical bills
📄 How it looks on a report
THIS IS NOT A BILL. Billed: $420.00. Allowed: $180.00. Plan paid: $144.00. You may owe: $36.00
🙅 What it does not mean
- An EOB is not a bill; do not pay from it directly.
- The "billed" amount is usually not what you owe; your share is shown separately.
- A denial on an EOB is not always final; you can ask questions or appeal.
🗒️ Questions to ask your doctor
🧾 Reports where you will see “Explanation of Benefits (EOB)”
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🔗 Read more from trusted sources
- “Explanation of Benefits (EOB)” on MedlinePlus ↗
US National Library of Medicine
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