What is an Explanation of Benefits?

Answer:
The Explanation of Benefits, or EOB, is a form

that the insurance company sends to you after you file a claim explaining the benefits that apply to the claim.

For example, a typical Explanation of Benefits will contain a description of the services including the provider, the date of services, what service was performed, the provider’s fee, the percentage payable after co-pays and deductibles and other reductions are applied, and an explanation of any portion of the claim that has been denied. The Explanation of Benefits also gives you information about how much of the claim was applied to your deductible.

In addition, the Explanation of Benefits form should also list contact information for clarification such as an 800 number that you can call to ask questions about the claim as well as information for appealing a denial for your claim.

The Explanation of Benefits isn’t a bill. It simply explains what has been paid to the provider on your claim and lets you know if the claim has been settled or denied. When a portion of the claim, or the entire claim, has been denied, the EOB will list the reason for denial.