How to read an EOB (Explanation of Benefits)

What an EOB is, and is not

An Explanation of Benefits is a summary from your health plan of the total charges for the care you received and how much you and your plan will pay. It is explicitly not a bill^source. The provider sends the actual bill separately. If the two do not match, that is a reason to ask questions before paying.

The key terms

Deductible: the amount you pay for covered services before your plan starts to pay. With a $2,000 deductible, you pay the first $2,000 of covered services yourself^source.

Coinsurance: the percentage of a covered service you pay after you have met your deductible, for example 20 percent^source.

Copayment (copay): a fixed amount, for example $20, you pay for a covered service^source.

Allowed amount: the maximum your plan will pay for a covered service. If your provider charges more than the allowed amount, you may have to pay the difference^source.

How to read it line by line

For each service, an EOB usually shows the amount the provider billed, the allowed amount, what the plan paid, and what you owe. Read across each line and ask: does the service match what I received, and does the patient responsibility match the bill the provider sent me? When a number looks off, that is where to focus your dispute. See how to dispute a medical bill.