What’s an Explanation of Benefits (EOB)?
An Explanation of Benefits (EOB) lists all of the medical services you received. It comes in the mail from the insurance company, and shows how much the insurance company paid and how much you will need to pay.
An EOB is not a bill, do not pay anything until you receive a bill. You may get more than 1 EOB for the same visit. Call your insurance company right away if you see a service you did not get.
What to do with an EOB?
A: Look at the “Services Provided” section and make sure it only has the services you received.
B: Check how much of the deductible you have paid.
A deductible is the amount you need to pay before the insurance company will start to pay it’s part.
C: Make sure you owe the same amount as your doctor bill.
If the insurance company rejected the bill, call them and ask how to file an appeal.
An appeal is the forms you fill out to tell the insurance company why they should cover the service you need.
What else does an EOB tell me?
A: Services Provided - Medical services your insurance company was billed for. Sometimes called “provider” and has the clinic name.
B: Provider Responsibility - This is how much your insurance should pay. Sometimes called “allowed amount”.
C: Amount Not Covered - What your insurance company does not pay for. Sometimes called “Plan Exclusions”.
D: Plan Paid - How much of the bill your insurance paid. This is usually the same amount as “Provider Responsibility”.
E: See Remarks - Usually has letter codes in it that are defined in another section. If your insurance company rejected the bill, they will list why here.
F: What You Owe - How much you will need to pay when you get the bill.
A deductible is the amount you need to pay before the insurance company will start to pay it’s part.
Co-Insurance is the percentage you pay for a service.
You can download a printable PDF of this information
Click the image to download a copy in English and Spanish.
