How to Read and Understand an Explanation of Benefits (EOB)

If you’ve ever received medical care in the U.S., chances are you’ve come across a document called an Explanation of Benefits (EOB). This document, sent by your health insurance provider, details how a medical claim was processed. While it’s not a bill, it’s an essential piece of information that helps you understand what was covered, what wasn’t, and why.

An EOB is a statement from your insurance company that breaks down the cost of care you received. It outlines the services billed by your healthcare provider, what the insurer paid, and what portion you may be responsible for. Receiving an EOB doesn't mean you owe money right away — instead, it serves as a summary of how your claim was handled.

The EOB helps you verify the accuracy of charges, detect potential billing errors, and ensure that your benefits are being applied correctly.

Most EOBs include the following sections:

Patient Information: This includes your name, the patient’s name (if different), and your insurance ID.

Provider Information: Details about the doctor, clinic, or hospital that provided the care.

Service Date and Description: The date(s) services were rendered and a brief description of each treatment or procedure.

Billed Charges: The amount your provider charged for each service.

Allowed Amount: The negotiated rate between your insurer and the provider — often lower than the billed charge.

Amount Paid by Insurer: The portion of the allowed amount that your insurance covered.

Patient Responsibility: The amount you may owe, including copayments, coinsurance, or deductibles.

Claim Number: A unique number for the claim. You’ll need this if you contact your insurer with questions.

Remarks or Notes: Explanations for any adjustments, denials, or partial payments.

Start by confirming that your personal and provider information is correct. Then, compare the services listed with your own records — such as receipts or your provider’s visit summary.

Pay close attention to the "Allowed Amount" versus the "Billed Charges." Insurers often negotiate lower rates with in-network providers, so you’ll usually see a discount applied here.

If the insurer didn’t cover a service in full, look at the remarks or notes for explanations. Common reasons include lack of medical necessity, service not covered, or missing documentation.

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If you see an error in your EOB — such as a charge for a service you didn’t receive or a denial you don’t understand — take the following steps:

Contact your provider to confirm the billed services.

Call your insurance company to ask for clarification.

Request a corrected claim if there’s a genuine mistake.

Keep all EOBs for your records, especially if you’re disputing a charge or tracking your deductible status.

Understanding your Explanation of Benefits (EOB) can give you clarity about your healthcare costs and help you manage your insurance effectively. While EOBs can seem technical, taking the time to review and understand them will ensure you're not overpaying and that your claims are processed correctly. Always double-check the details and reach out to your insurer or provider if anything seems unclear.