What an EOB contains
Every EOB includes the date of service, the name of the provider, each service that was billed with its procedure code, the amount billed by the provider, any adjustments the insurer applied (such as contractual discounts), the amount the insurer paid, and the amount the insurer says you owe.
The "amount billed" column reflects what the provider submitted to the insurer. The "plan paid" column shows what your insurer actually paid. The "your responsibility" column is what you legally owe under your plan, after the insurer's negotiated discount and your plan benefits are applied.
How to use an EOB to find billing errors
Compare the EOB to your itemized bill from the provider. Every service on the provider's bill should appear on the EOB. If a service appears on the bill but not on the EOB, the provider may not have billed the insurer for it correctly, or may be attempting to bill you directly for something the insurer was supposed to cover.
If the amount billed on the EOB differs from what the hospital sent you, contact both the hospital and your insurer. Providers occasionally submit incorrect codes or amounts to the insurer that differ from what they bill the patient.
Understanding denials on your EOB
The EOB will show a reason code for each service that was denied or not paid in full. Common reasons include "service not covered under your plan," "prior authorization required," "out-of-network provider," and "duplicate claim." Each reason code corresponds to a specific problem that may or may not be correctable.
A denial is not final. You have the right to appeal any denial. The EOB must include instructions for filing an internal appeal with your insurer. Under the Affordable Care Act, if your internal appeal is denied, you have the right to an independent external review.
EOB vs. bill: what you actually owe
You should never pay an amount that exceeds what your EOB shows as your responsibility, unless you received a corrected EOB after an appeal or dispute. If the hospital is billing you more than your EOB says you owe, that is an error. Contact your insurer first.
Keep every EOB. They are essential documentation if you need to dispute a bill, appeal a denial, or prove that a service was covered. Insurers are required to make EOBs available electronically, and most provide them through your online member portal within a few weeks of processing the claim.
Frequently asked questions
When will I receive my EOB?
Insurers typically send or post an EOB within 30 to 45 days after the claim is processed. Processing time varies. If you have not received an EOB within 60 days of your visit, call your insurer or check your online portal.
What should I do if my EOB shows a service I did not receive?
Contact your insurer immediately and report the discrepancy. Then contact the provider's billing department. A charge appearing on your EOB for a service you did not receive is a billing error. In some cases it is a sign of medical identity theft.
Do I get an EOB if I am on Medicaid?
Medicaid programs vary by state. Most state Medicaid programs provide member statements similar to an EOB, but not all. Contact your state Medicaid office to understand what claim documentation is available to you.
What is the difference between an EOB and a Medicare Summary Notice?
A Medicare Summary Notice (MSN) is Medicare's equivalent of an EOB. Original Medicare sends an MSN every three months if you had claims during that period. Medicare Advantage plans send EOBs similar to private insurer documents.