After your insurer processes a medical claim, they send you an Explanation of Benefits (EOB). It looks like a bill, but at the top it usually says "This is not a bill." So what is it, and why does it matter?
What an EOB Shows You
- What the provider billed (the "billed amount")
- What your insurer agreed to pay (the "allowed amount")
- What your insurer paid
- What you owe after deductibles, copays, and coinsurance
Why You Should Compare It to Your Hospital Bill
The EOB and the itemized hospital bill should tell the same story. If the hospital is billing you for procedures your EOB says were not billed to insurance, or shows a different date of service, that is a red flag worth investigating.
Appealing a Denial
If your EOB shows a denial or partial payment, you have the right to appeal. The EOB will include a denial reason code, look that code up on your insurer's website to understand exactly why the claim was denied and what documentation you'll need for an appeal.
📬 Keep every EOB for at least 3 years. They're your primary evidence if a billing dispute ever escalates.