What is an Explanation of Benefits (EOB) and what information does it typically show?

• A. An EOB is a statement from the insurer detailing how a claim was processed, including services covered, allowed amount, patient responsibility, and any remaining deductible or coinsurance.
• B. An EOB is a bill from the provider requesting payment for services.
• C. An EOB is a summary of benefits for the employer with no claim specifics.
• D. An EOB is a referral authorization for a specialist.

Answer: (A)

An Explanation of Benefits shows how your insurer processed a submitted claim. It details what services were covered, the allowed amount for those services, and your financial responsibility, such as any remaining deductible, coinsurance, or copays. It typically lists the billed charges, the amount the insurer paid, and what you may still owe to the provider. You’ll often see dates of service, provider names, codes describing the services, and any reason or denial codes if a service wasn’t fully covered. Importantly, an EOB is not a bill from the provider; sometimes you’ll receive a separate bill for the portion you owe after the EOB. The document can also show your remaining deductible or out-of-pocket max and may include notes about appeal rights or steps to dispute charges if something looks incorrect.