How to read an explanation of benefits (EOB)

It is not a bill

An explanation of benefits (EOB) comes from your insurer after a claim. It shows how the claim was processed. It is not a bill, so do not pay from it. Compare it with the bill from your provider first.

What you will usually see

Billed amount: what the provider charged.
Allowed or plan-approved amount: what the plan counts for that service.
Plan paid: what the insurer paid.
Your share: deductible, copay or coinsurance, plus anything not covered.
Notes or codes: short reasons for any denial or reduction.

Check these before you pay

The provider's bill matches the “your share” amount on the EOB.
The dates, provider and services are right, and nothing is billed twice.
The plan treated the care as in-network if it should have been.
Your deductible and out-of-pocket totals look correct.

If something is off

Ask the provider for an itemized bill, and ask the insurer to review the claim. If a service was denied, the EOB or a separate letter tells you why and how to appeal. See how to appeal a denial.

Want help writing your letter?
Upload your denial letter, explanation of benefits or bill to MyMedReply. It writes your appeal or dispute and cites the rules that usually apply. The draft is free; you pay only to copy it.
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This guide is general information, not medical, legal or insurance advice. Rules and deadlines vary by plan and state, so your denial letter and plan documents control. Medicare and Medicaid have their own appeal rules.