Definition: If you've visited your doctor or taken a trip to the emergency room, you have probably received a explanation of benefits (EOB), which is a statement from your insurer about your health claim. The EOB should include information about your provider, the date of service, the service itself, how much your provider charges for the service, how much the insurer considers to be a reasonable price for the service, and the amount they paid your health care provider. It may also include information on how much you, as the patient, may be responsible for paying.
It is important to remember the EOB is not a bill. This information is provided for your convenience. If you have question about how much you owe your provider, you should contact your provider.
The explanation of benefits should also provide an explanation if the insurer did not pay your provider. For example, if your doctor provides a service that is not covered by your insurance, your EOB should show that no payment was made and explain why. Should you disagree with the explanation provided, the EOB will contain information on how to appeal your insurer's decision.
