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. “EOB” is the commercial-plan name for the document and has no single federal definition, but Medicare structures the same pair of notices in regulation: the beneficiary receives a notice of initial determination carrying the reasons for the decision and how to seek a redetermination, while “an electronic or paper remittance advice (RA) notice is the notice of initial determination sent to providers and suppliers that accept assignment”.
In practice
An EOB is easily mistaken for a bill, and the distinction is worth making explicitly to patients: the plan’s notice reports a decision, and only the provider’s statement asks for money. The two documents also carry different content by design — the member notice explains the decision and the appeal route, while the provider’s remittance additionally carries “all applicable claim adjustment reason and remark codes to explain the determination”.
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.