An Explanation of Benefits is a familiar sight for most patients. They’re marked clearly at the top: “This is not a bill.” What’s less clear is the purpose of these documents.
“An Explanation of Benefits, or an EOB as a lot of folks call it, is essentially a receipt from your health insurance showing how a medical claim has been processed,” said Shawn Stack, a policy director at the Healthcare Financial Management Association. “It’s a breakdown of what your provider charged, what your insurance paid, and what portion, if any, you may owe.”
Insurers are required to send EOBs when providers submit claims, Stack said. Patients can use them by verifying that the services listed match what was performed and that insurance benefits were applied correctly.
The amount the insurer marks as the patient’s responsibility should match the billed amount. If it doesn’t, Stack recommends calling the hospital or doctor that sent the bill to figure out why.