Understanding the statement your insurance company sends after a claim.
An Explanation of Benefits is a statement your insurance company sends after processing a claim from a doctor, hospital, or other provider. It explains what was billed, what your plan paid, and what portion, if any, you may owe — but it is not itself a request for payment. Any actual bill will come separately from the provider.
A standard EOB shows the date of service, the provider, the total amount billed, the amount your insurance company negotiated or allowed, what the plan paid, and your remaining responsibility based on your deductible, copay, or coinsurance.
Insurance companies typically negotiate discounted rates with in-network providers, so the amount billed is often higher than the amount actually allowed or paid. This is normal and doesn't mean you owe the full billed amount.
It's worth comparing your EOB against any bill you receive from the provider to make sure the amounts match and that the service listed is actually one you received. If something looks off, your insurance company's member services line can help clarify the claim.
Have more questions? Visit our FAQ page or read the full Coverage Guide.