Understanding Your Explanation of Benefits (EOB)

After you see a doctor or get medical care, your insurance company sends you an Explanation of Benefits. It looks like a bill. It has dollar amounts on it. But an EOB is not a bill. It's a summary of what happened financially between your provider and your insurer. Your actual bill comes separately from the provider.

What an EOB Shows

The services you received, with dates and descriptions. The provider's billed amount (the full charge). The allowed amount (what your insurer agreed to pay based on negotiated rates). What insurance paid. What you owe (your share based on deductible, copay, or coinsurance). Whether any services were denied and why.

Why You Should Read Every EOB

Billing errors are more common than you'd think. Nearly 75% of patients who contact providers about billing errors get them corrected. Your EOB is where you catch these mistakes. Compare it to the bill you receive from your provider. If the numbers don't match, or if you see charges for services you didn't get, call both your insurer and the provider.

Common Things to Look For

Denied services that should have been covered. Duplicate charges for the same service. Charges for services you didn't receive. Incorrect coding (a diagnostic code that doesn't match your condition). A provider billed as out-of-network when they should be in-network. Preventive care that was charged instead of being covered at $0.

What to Do If Something Is Wrong

Call your insurer first using the number on the EOB. Ask them to explain any charges you don't understand. If a claim was denied, ask why and whether you can appeal. Then call the provider's billing department to compare their records. Keep notes on every call: who you talked to, the date, and what they said.