What does an explanation of benefits (EOB) provide to the insured?

An explanation of benefits (EOB) serves as a detailed account of the health care services that have been covered by an insurance policy, outlining the patient's costs associated with those services. It typically provides information on the types of medical treatments received, along with the total cost of the services, what the insurance plan will pay, and what portion of the costs are the responsibility of the insured. This includes any deductibles, co-payments, or co-insurance amounts that the insured will need to pay out-of-pocket.

The EOB is essential for helping insured individuals understand how their claims were processed, what benefits were utilized, and how much they may still owe for their medical bills. It does not serve as a record of all treatments received in a comprehensive sense or as a list of health plans; instead, it focuses specifically on the transaction between the provided care and the insurance coverage for that care, making it a vital communication tool for patients managing their health care expenses and planning for financial obligations related to their medical services.