What Is an Explanation of Benefits—and Why It Matters to You
An Explanation of Benefits (EOB) may look like a bill—but it’s not. It’s one of the most overlooked tools in your healthcare journey, yet it holds valuable insight into what your insurance paid, what was denied, and what you might still owe. If you’ve ever glanced at one and felt more confused than informed, you’re not alone.
The truth is, learning how to read your EOB isn’t just helpful—it can change the way you manage your care. It can help you catch errors, avoid duplicate payments, and understand your out-of-pocket responsibilities before a bill shows up. And once you know how to use it, you’ll never look at that piece of mail the same way again.
So, What Exactly Is an Explanation of Benefits?
An Explanation of Benefits (EOB) is a document your health insurance company sends you after you receive care. It tells you:
- What services or treatments were billed
- What your provider charged
- What your insurer paid
- What amount, if any, is left for you to pay
It’s essentially a receipt from your insurance company, not a bill from your provider.
Your EOB may also include:
- The date of service
- The name of the provider or facility
- Any adjustments (such as negotiated rate discounts)
- Denials or non-covered services (with reasons)
Why Should You Actually Read Your EOB?
Because mistakes happen. And because the EOB helps you take a more active role in your care. Here’s what paying attention to your EOB can do for you:
✅ Spot Billing Errors: Compare your EOB to your provider’s bill. If you’re being charged for something your insurer already paid, it’s time to call.
✅ Understand Denials: If something was denied, your EOB will usually explain why—and whether you have the right to appeal.
✅ Track Your Deductible and Out-of-Pocket Costs: EOBs help you see how much closer you are to reaching your annual limits.
✅ Avoid Surprise Bills: When you know what was covered and what wasn’t, you can be proactive—before the bill becomes a burden.
How to Use Your EOB Like a Pro
Start by reviewing each section line by line. Match it to:
- The date and services you received
- The doctor or facility you visited
- The amount your provider billed vs. what your insurance allowed
Keep your EOBs organized (digitally or in a folder) so you can reference them when disputes arise or tax season rolls around. If you use the Patient Better Self-Health Manager, this is a perfect place to store them!
Questions to Ask Your Insurance Company About Your EOB
If something doesn’t make sense—or something feels off—don’t hesitate to call. Here are five smart questions to ask:
- “Why was this service denied?”
Ask for the specific reason code and if you can appeal the decision. - “Can you explain the adjustments and allowed amounts?”
These amounts are often negotiated and can reduce your cost—but they can be confusing. - “Do I owe this amount, or will I get a separate bill from my provider?”
Make sure you understand what, if anything, you need to pay and to whom. - “Has this payment been applied to my deductible or out-of-pocket max?”
This helps you track your spending throughout the year. - “Can I get a corrected EOB or a written explanation?”
If anything is unclear or inaccurate, request clarification in writing.
Final Thoughts
Understanding your Explanation of Benefits is one of the first steps to becoming a more confident, capable partner in your care. It transforms you from a passive recipient of healthcare into someone who actively monitors, questions, and confirms what’s happening behind the scenes.
And the good news is, you don’t need to learn it all at once. With every EOB you read, your skill of being able to advocate for your health grows—and with Patient Better’s tools and resources, you’ll never be navigating alone.
Do you have any questions about your results or how to improve your healthcare proficiency?
Disclaimer: This education was brought to you today by The Patient Better Project Inc., a 501(c)(3) organization dedicated to reshaping the way patients and caregivers navigate care. We are committed to empowering individuals with the knowledge and tools necessary to take control of their health journeys, ensuring that everyone can access the care they need with confidence and clarity.
The information provided here is for educational and entertainment purposes only. It is not intended as, nor should it be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call 911 or your local emergency number.
