An Explanation of Benefits, often called an EOB, is a statement from a health plan showing how it processed a claim. It is generally not a bill. Layouts vary, but the document commonly identifies the patient, provider, service date, amount billed, plan discount, allowed amount, plan payment, and amount assigned to the patient.
Compare the key amounts
- Amount billed: what the provider submitted.
- Allowed amount: the amount recognized under the plan’s rules or contract.
- Plan paid: the payment issued by the insurer.
- Patient responsibility: amounts assigned to deductible, copayment, coinsurance, noncovered services, or other categories.
Check the message codes
Reason and remark messages explain why the plan processed an item in a particular way. Before paying a provider bill, compare it with the EOB, confirm that both documents refer to the same service, and ask questions when dates, providers, services, or responsibility amounts do not match.
Coverage and cost-sharing terms come from the specific plan documents. HealthCare.gov provides an official Summary of Benefits and Coverage overview and a uniform glossary that can help readers understand common insurance terms.
