An explanation of benefits (EOB) is not a bill. It simply tells you everything you might want to know about how your recent medical service was covered by your benefits plan. You’ll receive a bill from your provider for any amount you may owe.
Cost summary: The first page of your EOB is a summary of how much your provider billed, how much was covered by your plan and the total you may owe to your provider.
Benefits update: On the next page, you’ll find a breakdown of how much you and/or your family have applied toward your annual deductibles and out-of-pocket amounts.
Deductible: The amount you have to pay before your plan pays for specified services. Deductibles are usually an annual set amount.
Out-of-pocket: The most you could pay during a coverage period (usually one year) for your share of the costs of covered services. After you reach your “to go” amount, the plan will usually pay 100% of the allowed amount.
Service and payment details: This section includes information about who received the medical service, the name of the provider and what types of care they received. It gives you a breakdown of how the claim was processed, including:
How much your provider billed
Your network discount
The amount paid by your employer-sponsored plan
The amount you may owe, including co-pays, deductibles and out-of-pocket amounts
