How do I read my medical EOB (Explanation of Benefits)?


Since an EOB isn’t a bill, what you pay is for your information only.  If you owe the doctor, or hospital, they’ll send you an invoice. Comparing the EOB and the invoice is a good way to make sure you’re getting billed correctly by the doctor or hospital.

Not all claims generate an EOB. For example, you won’t get an EOB for a prescription. EOBs show you the costs associated with the services you received, including:

  • Claim Details, each service or procedure from each provider is explained
  • What the provider charged
  • What the allowed charges are (this is the contracted amount in which an in-network PPO provider agrees to accept as payment)
  • Any non-allowed charges (discount or amount billed over the contracted amount for this service)
  • What the Plan pays
  • Total covered
  • What you pay (summary of Deductibles, copays, and coinsurance)