After you use your health insurance, you’ll receive a document called an Explanation of Benefits (EOB). Many people mistake it for a bill — it isn’t. But it contains important information you should know how to read.
What Is an EOB?
An Explanation of Benefits is a summary statement from your insurance company explaining how a medical claim was processed. It shows what was billed, what the insurance company allowed, what the plan paid, and what you owe.
It is NOT a bill. The actual bill comes from your provider. But the EOB helps you verify that claims were processed correctly and understand your financial responsibility before the provider’s bill arrives.
Key Sections of an EOB
- Service date and provider: When the service occurred and who provided it
- Amount billed: What the provider charged (often far more than what’s actually paid)
- Contractual adjustment: The discount the carrier negotiated with the in-network provider — this reduces the “allowed amount”
- Amount allowed: The negotiated rate — what the carrier agreed the service is worth
- Plan paid: What the insurance company paid toward the allowed amount
- Your responsibility: What you owe the provider (deductible, copay, or coinsurance)
What to Check
- Was the claim applied to the correct plan year?
- Is the deductible amount applied correctly (does it match what you’ve spent so far)?
- Was the provider listed as in-network? (If you expected in-network and it shows out-of-network, there may be an error to dispute.)
- Does the service description match what you actually received?
What to Do If Something Looks Wrong
Call the member services number on your insurance card. You have the right to appeal claim decisions, and errors in processing are more common than you’d think.
Questions about an EOB or claim dispute? Garden State Benefits helps clients navigate insurance paperwork year-round — not just at open enrollment.