Question
Is an explanation of benefits a bill?
Short answer
No. An explanation of benefits (EOB) is your health plan's summary of a claim. The bill comes separately from the doctor or hospital, and it should match what the EOB says you owe.
How to read one
- Amount billed: what the provider charged.
- Allowed amount: what your plan has agreed to pay for that service. In-network providers can't charge you more than this.
- Plan paid: what the insurer paid.
- You may owe: your share, from your deductible, copay or coinsurance.
What to do with it
Keep the EOB until the bill arrives, then compare the two. If the bill asks for more than "you may owe", call the provider's billing office first, then your plan.
If the claim was denied, the EOB gives a reason code. You can ask the plan to reconsider through an internal appeal, and if it still says no, ask for an independent external review.
This is general information about how US policies usually work. Your own policy's wording and your state's rules decide the details.