Explanation of Benefits (EOB) (2024)

FAQs

Explanation of Benefits (EOB)? ›

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.

When a claim is approved, we either pay the health care provider directly or you do, depending on who submitted the claim. In most cases for in-network care, providers will submit claims for you and you'll receive an explanation of benefits, or EOB. Your EOB is not a bill but an explanation of how your claim was paid.

An explanation of benefits (EOB) is not a bill. It simply tells you everything you might want to know about how your recent medical service was covered by your benefits plan. You'll receive a bill from your provider for any amount you may owe.

EOB stands for Explanation of Benefits. This is a document we send you to let you know a claim has been processed. The most important thing for you to remember is an EOB is NOT a bill.

In summary, the SBC is a document that provides a summary of all available benefits on your insurance plan, while the EOB is a document that explains the coverage and costs associated with a specific healthcare service.

If you have insurance

An EOB is not a bill. An EOB is a summary of the care that you received and shows the amount your insurer is billed, how much your insurance will pay for that care, and the amount that you will owe.

An EOB is a statement from your health insurance plan describing what costs it will cover for medical care or products you've received. The EOB is generated when your provider submits a claim for the services you received. The insurance company sends you EOBs to help make clear: The cost of the care you received.

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 to read your EOB. The important things to check first are the services you received and the date you received them to be sure they're accurate. Next look for the plan paid amount, which is how much your insurance plan covered and paid to your doctor.

Should I keep an explanation of benefits? ›

The IRS advises taxpayers to keep relevant documentation for as long as they may be needed to verify deductions. If you plan to file a claim for a refund, keep EOBs and other tax documents for three years from the filing date of your original return or two years from when you paid your taxes — whichever is later.

Your EOB is a summary of the services and items you have received and how much you may owe for them. It tells you how much your provider billed, the approved amount your plan will pay, and how much you have to pay to the provider.

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.

The SBC is a snapshot of a health plan's costs, benefits, covered health care services, and other features that are important to consumers. SBCs also explain health plans' unique features like cost sharing rules and include significant limits and exceptions to coverage in easy-to- understand terms.

Claim: This is defined as a formal request for your insurance company to provide coverage for your medical expenses. EOB: A document that shows how much the insurance paid, your responsibility and what information may be needed to complete your claim.

An AOB is an agreement that, once signed, transfers the insurance claims rights or benefits of your insurance policy to a third party. An AOB gives the third party authority to file a claim, make repair decisions and collect insurance payments without your involvement.

Path to improved wellness. After you visit your doctor, your doctor's office submits a bill (also called a claim) to your insurance company. A claim lists the services your doctor provided to you. The insurance company uses the information in the claim to pay your doctor for those services.

Health insurance carrier Explanations of Benefits (EOBs) are excellent receipts because they carry all this information. You can download these from your insurance carrier's website. Most walk-out statements from office visits also contain the required information.

Explanation of Coverage (EOC) details the terms and conditions of a health insurance plan, while Explanation of Benefits (EOB) outlines the costs and payments for specific medical services.

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.