What Is an EOB?
An Explanation of Benefits (EOB) is a document your insurance company sends after processing a medical claim. It is not a bill โ it is a summary of how the claim was handled and what you may owe your provider.
๐ก Wait for your EOB before paying any medical bill. The bill from your provider may be incorrect or may not reflect what your insurance actually owes.
Key Sections of an EOB
1. Provider Information
The name of the doctor, hospital, or facility that submitted the claim, and the date of service.
2. Amount Billed
What the provider charged โ often much higher than what actually gets paid. This is the starting point, not what you owe.
3. Negotiated / Allowed Amount
The discounted rate your insurer has negotiated with the in-network provider. This is the actual cost your insurer works from โ not the billed amount.
4. What Insurance Paid
How much your insurer paid toward the claim.
5. Your Responsibility
What you owe the provider โ broken down into deductible, copay, and coinsurance amounts. This is the number that matters most.
6. Deductible Accumulator
How much of your annual deductible has now been met. Essential for tracking your progress through the year.
What to Check on Every EOB
- Is the date of service correct?
- Is the provider name correct?
- Was the claim processed as in-network?
- Does the deductible amount match your running total?
- Does the "your responsibility" amount match what the provider billed you?
What to Do If Something Looks Wrong
Call the number on the back of your insurance card. Reference the claim number on the EOB. Common errors include: out-of-network processing when the provider is in-network, incorrect procedure codes, and deductible not properly applied.
Track Your Deductible Progress
Use your EOB amounts to track exactly how much deductible you've met this year.
Track Your Deductible Progress โ