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Explanation of Benefits

An explanation of benefits or EOB (also sometimes called an EOP, R&S or SOP) is not a bill, but rather a summary or explanation of services sent to you after a visit to a doctor, clinic, hospital or other medical service provider.

An explanation of benefits summary shows you and your medical provider what portion of the charges is eligible for benefits under your specific plan.

Why should you read your EOB?

The EOB is a summary of all charges and payments. Reviewing it helps to reduce the risk of costly billing errors.

The EOB typically provides information:

  • The patient's name
  • Service provided
  • Fee (dollar amount) charged by the medical provider
  • Percentage and/or amount covered and not covered under your plan
  • Dollar amount paid to your provider by your health insurance plan
  • Dollar amount, if any, you are responsible for paying

The EOB can help prevent cosly errors

  • Billing mistakes
  • Miscalculating your coinsurance amount
  • Medical identity theft
  • Outdated insurance plan information

If you have questions

If you have questions about items on the summary or how benefits were determined, there are several ways to get more information on how your services were processed by your insurance company:

  • Some insurance company's mail member's an explanation of benefits automatically after they process a claim for services.
  • You may get several EOBs for the same service. In some cases each provider will bill separately for the specific service they provided. Learn more about your bill here.
  • If you have questions about how your health insurance plan processed your claim for services, please call your member services number located on your insurance card.
  • In most cases, you can also go to your insurance company's website and follow the instructions to view your account information.