How to Read and Understand Your Insurance EOB


How to Read and Understand Your Insurance EOB

Sthethoscope and medical documents

If you’ve ever received medical care and wondered how much your insurance will cover, you’re not alone. A document from your insurance company, the Explanation of Benefits (EOB), contains important information to help you understand what you might have to pay.

EOBs can be confusing for many folks, and reading the details of this insurance statement can feel like trying to decipher a secret code. Below we’ll explain how to read an EOB, and answer some common questions as well as cover a few key terms you should know about EOBs.

What is an Insurance EOB?

An EOB is a document issued by your health insurance company that serves as a detailed record of how your medical claims have been processed and what costs are covered by whom. Essentially, it’s a complete summary of the financial transactions between your healthcare provider, the insurance company, and yourself.

Think of an EOB as a detailed receipt that provides a breakdown of the entire billing process, offering transparency into how your insurance benefits were paid out. It outlines the medical services you received, the costs billed by your provider, how much your insurance company will cover, and the remaining dollar amount that you owe.

The Difference Between an EOB and a Medical Bill

One common source of confusion is understanding the difference between an EOB and a medical bill. While both documents relate to healthcare expenses, they serve different purposes in the billing process.

After each medical appointment, your healthcare provider’s office bills your insurance. The insurance company processes the claim and pays the provider based on the contract they have with that provider. Then, they send you an EOB statement with information on what they paid and what you may owe. An EOB, as mentioned earlier, is a summary of the entire insurance claim process from beginning to end.

After your insurance has processed the claim, they will let your provider know how much they paid and how much you are responsible for. If there’s a balance that is your responsibility, your provider will send you a medical bill.

This medical bill outlines the total charges for the services you received and specifies the amount you need to pay. Your portion might include deductibles, copayments, or any remaining balances after payment from your insurance company has been processed.

Key Components of an EOB

Understanding your Explanation of Benefits involves reading carefully through the information in the document. Here’s a breakdown of the common sections found on an EOB:

Patient Name

The patient name listed on the EOB identifies the person who received the medical services on the specified date. If multiple family members are on the same insurance policy, the Patient Name section helps identify which person’s medical claims were paid by the insurance.

Claim Number

The claim number is a reference number specific to the medical visits listed on the EOB. If you need to call your insurance company with questions about the claim, the claim number is an easy way for the customer service representative to pull up your dates of service.

Date of Service

This section shows the dates on which the healthcare services were provided.


This section lists the name of the healthcare provider who delivered the medical services to you.

Description of Service

Includes a detailed breakdown of the medical services or procedures you received (sometimes accompanied by numbered billing codes that identify each service).


This section outlines the total dollar amounts charged to your insurance for each service you received from your healthcare provider(s), and what the insurance paid.

Types of charges include:

  • Total charges – the amount the provider charged your insurance for the services you received. This may also include a facility charge if you received services at a hospital. If you saw more than one provider, you will get a different EOB for each provider. For example, if you had imaging done, you may get one EOB for the X-ray itself and one for the radiologist who read the image. If you had surgery, you may get separate EOBs for the surgeon, the surgical assistant (if there was one), the surgery center, etc.
  • Discount – identifies the amount your claim was reduced, based on the insurance company’s contract with your provider.
  • Allowed charges – the total amount the insurance company approved to be paid to your provider (by the insurance company and the patient combined).
  • Paid by insurer – the amount the insurance company paid your provider.
  • Patient responsibility – this is the amount you owe after your insurance has paid the claim. May include copay, coinsurance, deductible, or other amounts not covered by your insurance. If you have already made a payment toward this balance, it may not yet be reflected on the EOB.

The titles of these charges may differ on your EOB, depending on who your insurance company is.

Reviewing your Explanation of Benefits

It’s a good idea to review your Explanation of Benefits each time you receive one, to make sure the information on it is correct and that what you owe is accurate.

First, look at the Provider and Date of Service information. Confirm that the provider’s name, contact details, and service date correctly list the actual healthcare provider, location, and date that you had the appointment.

Next, look at the Description of Services. If you had an annual checkup, labs, surgery, or something else, make sure the treatments or procedures listed on the EOB correctly show the reason(s) for your visit.

Finally, in the Charges section, review the total charges for each service against your expectations or any cost estimates you received prior to the appointment or procedure. This step allows you to see what was paid by your insurance and how much you will be billed.

If you identify any errors or discrepancies on your EOB, or have questions about the charges listed in this section, contact your insurance company for clarification.

If your EOB shows a specific dollar amount you owe, but you haven’t received a bill from your healthcare provider yet, contact your provider’s office to confirm the amount due before paying.

If your EOB does not include all healthcare services you’ve received recently, keep in mind it typically covers a specific timeframe, so some appointment claims may not have been processed yet by your insurance.

Tracking Your Healthcare Costs

Regular reviews of your EOBs are a useful way to track your healthcare costs and to confirm that you have the right level of insurance coverage for your medical needs.

An EOB provides insights into the healthcare services you and your family have received over the past months or years, and the extent of coverage provided by your insurance plan. Knowing this information can help you make informed decisions about your medical care and help you plan appropriately for out-of-pocket costs.

Please note: it is your responsibility as a patient to understand your insurance coverage. To be sure a provider or service is in-network, check with your insurance company before appointments or procedures for cost estimates so you know what to expect when the bill comes.

Glossary of EOB Terms

Understanding the language and terms on an EOB can feel overwhelming. Here is a short glossary to help:


A fixed amount you pay out of pocket for a specific service. The copay is typically due on the day of your appointment or surgery. Copays vary by insurance plan, but commonly range between $10 – $40 for outpatient medical appointments.


The amount you must pay out of pocket for medical services before your insurance starts sharing part of the cost. Although you may see a discount applied in the Charges section of your EOB, the balance of appointment charges are generally not covered until your deductible is met. Deductible amounts vary widely by the type of insurance plan and level of coverage you have.


The percentage of costs of a healthcare service you’ll pay after you’ve met your deductible. The coinsurance percentage may differ by type of service.

For example, say that your deductible is $2000 and you’ve already paid that out of pocket for medical care this year. If your coinsurance is 20% on office visits with an in-network primary care provider, when you next see your provider (who is in-network), you will owe 20% of the allowed charges for that visit.

Out-of-Pocket Maximum:

The most you have to pay out of pocket for services covered by your insurance in a plan year. Once you reach this limit, your insurance pays 100% of the benefits covered in your plan.

The out-of-pocket maximum amount acts as a financial safety net for patients, capping the total amount you will have to pay for yourself and/or your family members. Out of pocket maximums vary by insurance plan.

Patient Responsibility:

The amount that you are required to pay for the healthcare services you have received. This includes copays, deductibles, and coinsurance.

In Summary

The Explanation of Benefits statement can seem overwhelming and confusing. Understanding a few key terms and how to read your EOB can help. When it comes to deciphering your EOB, the bottom line is clear: knowing what you’ll have to pay out of pocket for healthcare can make all the difference in your finances and your well-being.