An explanation of benefits, or EOB, is a document you receive from your insurance after a provider has filed a claim. Your EOB outlines what your plan covers and what you owe for services. An EOB is not a bill, but rather an explanation of the 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.
Understanding how to read your EOB can help ensure you’re being charged correctly for the services you receive.
When should you get an EOB?
Generally, you receive an EOB after your claim is processed.
How to read 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:
- Patient information: This will list your name, address, member ID, and insurance group number.
- Provider information: This will include the provider's name, location, date, and any applicable reference numbers or medical codes.
- An overview of services provided: This will catalog the services provided, such as doctor visits, treatments, laboratory tests, or surgeries. The date of service and a brief description of services will also be included.
- The cost of service: This outlines how much was billed for the service, the amount your plan pays, and your financial responsibility.
- Deductible details: If applicable, this will say how much of your deductible you’ve met so far for the year.
- Copayment or coinsurance responsibilities: If required, this will detail what copay (a fixed amount) or coinsurance (a percentage of the total bill) you owe for the service.
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.
Here’s an example EOB, broken down line-by-line, to help you confidently read and interpret your own.