The document that confuses people into overpaying, and how to actually read it. An EOB is not a bill. Do not pay it.
An Explanation of Benefits is a document your insurance company sends every time a claim is processed on your behalf. It summarizes how the claim was processed — it is not a request for payment. Paying it before you receive an actual bill from your provider can result in double-paying.
| Section | What It Means |
|---|---|
| Billed Amount | The chargemaster price your provider submitted. Almost always higher than what anyone pays. Do not be alarmed by this number. |
| Plan Discount / Adjustment | The amount reduced based on your insurer's contracted rate with your in-network provider. |
| Amount Paid by Plan | What your insurer actually paid to the provider after applying your deductible, copay, and coinsurance. |
| Your Responsibility | The insurer's calculation of what you MAY owe. Should match your provider's bill — but does not always. |
| Not Covered | Any amount the insurer did not pay. If you believe the service should have been covered, this is a denial that can be appealed. |
Review each EOB when it arrives and check: Is the service date and description correct? Does the provider name match who you actually saw? Is anything listed as not covered that should have been? Does your responsibility match your plan's cost-sharing structure? Keep your EOBs for at least a year — they are your record of what your insurer processed and when.
