EOB (Explanation of Benefits)
An EOB is the statement a health plan sends the patient explaining how a claim was processed — what was billed, allowed, and paid, and what the patient owes. It is not a bill.
Updated
An Explanation of Benefits (EOB) is a document a payer sends to the member (patient) after processing a claim. It shows the billed amount, the plan’s allowed amount, what the plan paid, and the patient’s responsibility — deductible, copay, or coinsurance.
An EOB explains a coverage decision; it is not a request for payment.
In practice
Patients frequently mistake an EOB for a bill, which drives avoidable calls and confusion. Clear communication that distinguishes the EOB from the provider’s statement is part of a good patient financial experience.
Commonly confused with
- ERA / EOP: The Electronic Remittance Advice (X12 835), or Explanation of Payment, is the payer’s remittance to the provider — the EOB is the member-facing version.
- Statement / bill: The provider’s statement is the actual request for the patient’s balance.