After a doctor’s visit, hospital stay, or medical procedure, you might receive a document called an Explanation of Benefits (EOB). While it may look like a bill, it’s not one. The EOB is a summary sent by your health insurance company that explains what services were billed, what your insurance covered, and what you might owe. Understanding how to read your EOB can help you spot billing errors, track your deductible, and avoid surprise costs. Here’s how to make sense of this important document and use it to stay on top of your healthcare spending.
What Is an Explanation of Benefits (EOB)?
An EOB is a statement—not a bill—that your insurance provider sends after you receive medical care. It outlines:
The services you received
The amount your provider charged
What your insurance plan paid
What portion (if any) you’re responsible for
Even if your provider accepts your insurance, your plan might not cover everything, which is why the EOB helps break down the cost-sharing details.
Why EOBs Matter
EOBs help you:
Understand your share of the cost for a service
See how close you are to meeting your deductible or out-of-pocket maximum
Catch billing errors or services you didn’t receive
Track your healthcare spending over time
Getting in the habit of reviewing your EOBs can prevent unnecessary charges and give you better insight into your benefits.
Where You’ll Receive Your EOB
Your insurance company may send EOBs:
By mail, a few weeks after your appointment
Through a secure online portal, where you can view or download them
Via email notifications, with a link to log in and access the document
Make sure your contact information is current with your insurer so you don’t miss these important updates.
How to Read Your EOB: Section by Section
While formats vary by insurer, most EOBs include similar sections. Here’s how to break it down:
1. Member Information
This section includes your:
Name
Policy number
Claim number
Date of service
Use this info to match the EOB with your recent appointments or treatments.
2. Provider Information
This shows who provided the care—such as a doctor, hospital, or clinic. If the name doesn’t look familiar, double-check the date or location to confirm the service.
3. Description of Services
Each row typically represents one service or procedure, listed with:
Procedure code (CPT or HCPCS)
A brief description (e.g., “lab tests” or “office visit”)
The date the service was provided
4. Amounts Billed and Paid
This section often includes columns like:
| Label | What It Means |
|---|---|
| Billed Amount | What the provider charged your insurance |
| Allowed Amount | The negotiated rate your insurance agrees to pay |
| Insurance Paid | What your insurance actually paid |
| Patient Responsibility | What you may owe (e.g., deductible, copay, or coinsurance) |
Tip: You usually don’t owe the full “billed amount.” Focus on the patient responsibility line instead.
5. Your Cost Breakdown
This is where the EOB tells you how your payment was calculated. It may include:
Applied to deductible: If you haven’t met your deductible, part of the cost goes here
Coinsurance: A percentage of the allowed amount you’re responsible for
Copayment: A fixed fee you pay for certain services
Non-covered amount: Costs not covered by your plan (e.g., out-of-network charges)
If your insurance didn’t cover something, the EOB should explain why.
6. Year-to-Date Totals
Many EOBs show how much you’ve:
Paid toward your deductible
Paid out-of-pocket for the year
Had covered by your insurance
Tracking this helps you anticipate when your insurance will start covering more (especially after you meet your deductible or out-of-pocket max).
What If You Receive Multiple EOBs?
If you had several services during a single visit (like lab work and a consultation), you might receive separate EOBs for each provider or department involved.
Also, if you have multiple insurance plans (like a primary and secondary plan), you may receive EOBs from both.
EOB vs. Medical Bill: What’s the Difference?
An EOB is not a bill. It’s a summary from your insurance company showing what they paid and what you might owe.
The actual bill comes from your provider and will match (or closely reflect) the “patient responsibility” shown on the EOB.
Always compare your EOB with the provider’s bill to make sure:
The charges match
Insurance was applied correctly
You’re not being billed for something you already paid
Common EOB Issues to Watch For
Duplicate charges
Incorrect patient responsibility amounts
Claims for services you didn’t receive
Out-of-network billing errors
If something looks wrong, contact your insurer’s member services department. You can also reach out to the provider’s billing office for clarification.
What to Do If You Disagree with an EOB
If you think your insurance didn’t cover something it should have:
Call your insurance company to ask about the claim
Request a review of the decision
File a formal appeal, if necessary
Keep documentation of every call, letter, and email
You have the right to appeal decisions, and sometimes errors can be resolved with a simple phone call.
Final Thoughts
Your Explanation of Benefits may not be the most exciting mail you receive, but it’s one of the most important. Understanding how to read your EOB can save you money, prevent billing errors, and help you make better use of your health insurance. Don’t toss it aside—take a few minutes to check that everything looks right. Your wallet (and your peace of mind) will thank you.
