Insurance EOB Explained (Plain English)

An Explanation of Benefits (EOB) is a statement from your insurer about how a claim was processed. It is not a bill.

What an EOB is (and is not)

• Is: a record of how insurance handled a claim.
• Is not: a demand for payment (that would be a provider bill).

The 6 numbers most people care about

1. Amount billed: what the provider charged.
2. Allowed amount: the insurer’s negotiated rate.
3. Adjustments / discounts: billed minus allowed.
4. Insurance paid: what the insurer paid the provider.
5. Deductible: amount you must pay before coverage kicks in.
6. Patient responsibility: amount that may be yours (often shown as copay/coinsurance/deductible).

Common confusing terms

• Copay: fixed amount per visit/service.
• Coinsurance: percentage you pay after deductible.
• Out-of-network: provider not contracted with your plan.
• Denied: insurer did not cover a portion (various reasons).

What’s worth double-checking (neutral)

• Does the service date match what you received?
• Are provider and patient names correct?
• Is the claim marked in-network or out-of-network as expected?
• Do deductible and coinsurance amounts match your plan expectations?