An explanation of benefits is a statement your insurer sends after a claim. It typically says “this is not a bill” somewhere on it, and that’s accurate — it’s the accounting behind the bill that arrives separately from the provider.
Read it in this order:
| Line | What it means |
|---|---|
| Amount billed | The provider’s list price. Rarely what anyone pays. |
| Allowed amount | The negotiated rate. The real number. |
| Plan paid | The insurer’s share. |
| Patient responsibility | Your deductible, copay or coinsurance. |
| Denied / not covered | Where disputes start. |
Why it’s worth ten minutes. Compare the EOB against the provider’s bill. If the provider bills you more than the “patient responsibility” line for in-network care, that’s balance billing, and in most in-network situations it isn’t allowed. Compare against your own memory too: services you didn’t receive and duplicate charges show up here more often than people assume.
Keep EOBs for the year. If bills from twelve months exceed 10% of your gross annual income, they’re the evidence for a hospital financial assistance application even when you’re insured.
Also called: EOB. Reference: Explanation of benefits (EOB) on Wikipedia — general definition, not New York specifics.
More in Glossary of health coverage and billing terms
- Navigator — A certified, free helper who walks you through enrollment and earns no commission on your choice.
- Sliding scale fee — A charge set by your income rather than a fixed price list. The standard at community health centers.
- Good faith estimate — A written cost estimate uninsured and self-pay patients are entitled to before scheduled care.
This page explains how the system works. It is not medical advice. More.