Employee Benefits
What Is an Explanation of Benefits (EOB)?
An explanation of benefits, or EOB, is a document you receive from your insurance plan after a provider has filed a claim. EOBs outline what your plan covers and what you owe for services. An EOB is not a bill, but rather an explanation of services provided and how the cost is split between you and your insurer. Typically, you’ll receive an EOB shortly after a visit to a provider or after you make a purchase covered by your insurance — such as a prescription or piece of medical equipment.
When should you get an EOB?
Typically, you’ll receive an EOB 30 to 60 days after receiving care.
What’s included in an EOB?
Your explanation of benefits is an overview of the services you received and what they cost. The document you receive will likely include:
- An account summary: This will list your name, address, member ID, and insurance group number.
- An overview of services provided: This will include the services provided, provider’s name, location, date, and any applicable reference numbers or medical codes.
- The cost of service: This outlines how much was billed for the service, the amount your plan pays, and your financial responsibility.
Your EOB will outline whether your insurance claim was approved or denied. It could also include additional information, such as services your plan didn’t cover and your progress toward your deductible.
EOB example
Here’s an example EOB, broken down line-by-line, to help you confidently read and interpret your own.
What to do with an explanation of benefits
An EOB contains important information that you should always review. When you receive an explanation of benefits, read it carefully to ensure you’re being charged for the correct services at the correct cost. Compare it to any corresponding bills or statements from your insurance carrier to ensure you’re not being charged for services you didn’t receive. Under the January 2022 No Surprises Act, you’re protected from unexpected medical bills. For example, if you have a medical emergency and go to the closest facility, they must inform you of the charges associated with your care — regardless of whether they’re an in-network vs. out-of-network provider.
By understanding your EOB, you can verify what you’re being charged matches what you were told and that you’re billed accurately.
EOBs: The bottom line
An explanation of benefits is a document from your insurance company outlining the services you received and how much they cost. You should receive it within 30 to 60 days of services provided, but it’s not an official bill. Take care to review your EOB to ensure you understand recent charges and they all are accurate.
Ready for Open Enrollment?
This article is intended to provide general information about insurance. It does not describe any Metropolitan Life Insurance company product or feature.