Explanation of Benefits (EOB)
A statement from your health insurer showing how a claim was processed — not a bill, but the reason code tells you why something wasn't covered.
An Explanation of Benefits (EOB) is issued by your health insurer after processing a medical claim. It shows how much was billed, how much the insurer paid, and — critically — why any portion was reduced or denied.
Why it matters
The EOB is your primary evidence in a billing dispute. If the insurer applied the wrong network discount, denied a covered service, or misclassified a procedure, the EOB is where that error appears.
What it is not
An EOB is not a bill. You may receive it before the provider sends you a statement. Do not pay anything based solely on the EOB — wait for the provider’s bill and verify the amounts match.
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