How to read your Explanation of Benefits (EOB)
Your EOB is the statement your plan sends after processing a claim. Here's what every column means.
An EOB is NOT a bill. It's an informational statement showing what was billed, what the plan paid, and what you owe. Providers send separate bills. The EOB has standard columns: (1) Date of Service, (2) Provider, (3) Service Description / CPT code, (4) Billed Amount (what provider charged), (5) Allowed Amount (what plan considers payable based on negotiated rate), (6) Plan Paid, (7) Patient Responsibility, (8) Adjustment Reason (CARC + RARC codes), (9) Notes / Member Messages.
Frequently asked questions
Is an EOB a bill?
No. An EOB is an informational statement from your insurer. Bills come separately from providers. NEVER pay from an EOB — wait for the provider's bill and reconcile it against the EOB before paying.
What's the difference between 'Billed Amount' and 'Allowed Amount'?
Billed Amount is the provider's full charge (rack rate). Allowed Amount is what the plan considers payable based on the negotiated in-network rate. The difference is a contractual write-off for in-network providers — you don't owe it.
What's 'Patient Responsibility'?
The dollar amount you actually owe — typically your deductible, coinsurance, copay, or out-of-pocket maximum applications. This is what should match the provider's bill.
What if the bill doesn't match the EOB?
Don't pay. The provider may have made an error. Reconcile against the EOB and ask the provider's billing office for an explanation before paying.
More EOB guides
- EOB vs bill — what's the difference?Don't confuse them. EOB is informational; bill is what you actually pay.
- My EOB shows I owe money — what does it mean?Several reasons you might owe — and some are appealable.
- Secondary insurance EOB — what does it mean?When you have two plans, both send EOBs. Read them in the right order.
- There's a denial on my EOB — what do I do?Diagnose the CARC code, then either appeal or accept based on whether the code i
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