Reading an explanation of benefits can be confusing. On this page, you’ll learn what an explanation of benefits is for, and how to read one.
See what an explanation of benefits looks like (PDF)
What’s an explanation of benefits?
An explanation of benefits (EOB) shows you the total charges for your visit.
An explanation of benefits isn’t a bill.
It helps you understand how much your health plan covers, and what you'll pay when you get a bill from your provider.
What’s on an explanation of benefits?
General information about you and your health plan
The explanation of benefits includes information about:
- You (the patient)
- Your health plan
- Who provided your care, and when it was provided
- A reference number called the claim number
- The person who gets reimbursed for any overpayments, called the payee
It will also list your health plan’s phone number. Call your health plan if you have questions about finding a provider or what services they cover.
Details about your claim(s)
The explanation of benefits gives you details about your care, like:
- The date of service
- A service description. This explains what service you had, like a medical visit, lab test, or screening.
Information about your bill
The explanation of benefits lists the cost of your care, and how much your health insurance company will pay.
- “Provider Charges” is the amount your provider bills for your visit.
- “Allowed Charges” is the amount your provider will be paid. This may not be the same as the Provider Charges.
- “Paid by Insurer” is the amount your health plan will pay to your provider.
What you owe
What You Owe, or Patient Balance, is the amount you owe after your insurer has paid everything else.
You may have already paid for part of the Patient Balance. The Explanation of Benefits only shows what you owe, not if you’ve already paid for it.
Your bill should not be higher than the Patient Balance. If it is, talk to your provider.
Remark code
A remark code is a note from the health plan that explains more about the costs, charges, and paid amounts for your visit.
The code is usually 2 or 3 letters and numbers. Check the bottom of the explanation of benefits for a description of each code.
FAQs
How do you read an EOB?
- Your patient details.
- The medical services you received and from who.
- Amount billed–cost of those services.
- Discounts–any money you saved by accessing care or medical products from within your plan's network of providers.
- Amount paid by your health insurance plan.
An EOB shows how much your health care provider is charging your insurance company and how much you may be responsible for paying. This is not a bill. If you owe money, you will receive a separate bill from your health care provider. Individual EOBs are likely to differ from the example provided.
How do you understand an insurance EOB? ›
What is an Explanation of Benefits? Each time your insurer pays for a service you use, they send you an Explanation of Benefits (EOB). The EOB is your insurance company's written explanation for that claim, showing the name of the provider that covered the service and date(s) of service.
What are the 5 pieces of information found on an EOB? ›
The EOB will show a variety of information, including details about the medical treatment, the amount that was billed, the amount that the health plan allows for that service, the amount the health plan paid (if any), and the amount that the patient owes.
How do you analyze benefits? ›
Steps of a Cost-Benefit Analysis
- Establish a Framework for Your Analysis. ...
- Identify Your Costs and Benefits. ...
- Assign a Dollar Amount or Value to Each Cost and Benefit. ...
- Tally the Total Value of Benefits and Costs and Compare.
Anything billed above and beyond the allowed amount is not an allowed charge. The healthcare provider won't get paid for it, as long as they're in your health plan's network. If your EOB has a column for the amount not allowed, this represents the discount the health insurance company negotiated with your provider.
How do you explain benefit? ›
benefit noun (ADVANTAGE)
a helpful or good effect, or something intended to help: The discovery of oil brought many benefits to the town.
What is the standard explanation of benefits? ›
Information about your bill
The explanation of benefits lists the cost of your care, and how much your health insurance company will pay. “Provider Charges” is the amount your provider bills for your visit. “Allowed Charges” is the amount your provider will be paid.
What is a typical EOB? ›
An EOB includes a table that normally lists individual services, the amount your insurer paid, your deductible and copay amounts. These tell you how much your insurer has agreed to cover how much you may owe.
What is the meaning of EOB code? ›
An Explanation of Benefits (EOB) code corresponds to a printed message about the status or action taken on a claim. Providers will find a list of all EOB codes used with the corresponding description on the last page of the Remittance Advice. THIS CLAIM/SERVICE IS PENDING FOR PROGRAM REVIEW.
How do I Interpret the documents?
- The first column is a Description of the item to be repaired. ...
- The second column refers to the Quantity. ...
- The third column on each of the spreadsheets refers to the Unit Price. ...
- The Depreciation column is listed next showing how much depreciation has been withheld for each component.
You should always save your Explanation of Benefits until you get the final bill from your doctor or health care provider. Insurance companies make it easy for members to view past EOBs online, so there's no need to keep a paper copy if you have an online account.
What does "not covered" on EOB mean? ›
EOB Denials
The service you had is not covered by the health insurance plan benefits (also called a non-covered benefit). Your insurance coverage was ended (terminated) before you received this service. You received the service before you were eligible for insurance coverage (not eligible for coverage).
How accurate are EOBs? ›
EOBs tend to be quite accurate, but there can sometimes be errors. They can result from a mistake made by the medical billing office or by the health plan. So before paying any medical bills, it's important to carefully review EOBs to make sure that all of the numbers match up with what you expect.
How would you explain what an explanation of benefits form is? ›
An explanation of benefits is a document that explains how your insurance processed the claim for the services you received. It breaks down the information like this: The services we provided. What the doctor or hospital charged (all charges)
How do you interpret net health benefits? ›
A positive NHB implies that overall population health would be increased as a result of the new intervention, whilst a negative NHB implies that the health benefits of the new intervention are not sufficient to outweigh the health losses that arise from the healthcare that ceases to be funded in order to fund the new ...
How do you interpret benefit cost ratio? ›
If a project has a BCR greater than 1.0, the project is expected to deliver a positive net present value to a firm and its investors. If a project's BCR is less than 1.0, the project's costs outweigh the benefits, and it should not be considered.
