Module 09 · Costs & Medical Bills, Using Your Coverage

Understanding Your EOB

How to read an Explanation of Benefits — and why it is not a bill.

After you receive care, your health plan may send you an Explanation of Benefits (EOB). It shows how a claim was processed. This module explains the main parts and how to use them.

An EOB is not a bill

AN EOB IS NOT A BILL.It explains how your plan processed a claim. A bill, if any, comes from the provider.

The main parts of an EOB

Claim: A request for payment sent to the plan for services you received.
Amount billed: The amount the provider charged for the service.
Allowed amount: The amount the plan recognizes for a covered service. For in-network providers, this is usually the negotiated rate.
Plan payment: The amount the plan paid toward the allowed amount.
Member responsibility: The amount you may owe, such as deductible, copay, or coinsurance, and any amount not covered.

Compare before you pay

When a bill arrives from a provider, it can help to compare it with the EOB for the same service:

Do the dates of service and provider name match?
Does the amount on the bill match the member responsibility on the EOB?
Was the claim processed as in-network or out-of-network?
Are there any denied services or notes you do not understand?

If something does not match, contact your plan or the provider’s billing office to ask questions.

Real-life example: Reading Anna’s EOB (fictional example)

EOB line	Amount
Amount billed	$1,200
Allowed amount	$800
Plan payment	$640
Member responsibility (20% coinsurance)	$160

Anna has already met her deductible. The in-network provider billed $1,200, but the allowed amount is $800. Her plan paid $640, and her coinsurance is $160. When the provider’s bill arrives, Anna checks that it asks for $160 and matches the EOB before paying.

Fictional EOB example showing $1,200 billed, $800 allowed, $640 paid by the plan, and $160 member responsibility, with a comparison to a $160 provider bill and the reminder that an EOB is not a bill.

Key takeaways

An EOB explains how a claim was processed. It is not a bill.
Key lines: amount billed, allowed amount, plan payment, and member responsibility.
Compare provider bills with the EOB and ask your plan or provider about differences.

Educational information only. Examples are fictional and do not describe any real insurer or plan. Health-plan terms and requirements vary — always verify information using your official plan documents. Read the disclaimer.