Decode this · Sample document
An explanation of benefits (EOB), explained
What your health plan says it paid, and what you might owe. Not a bill. Sample only: every name and number is made up.
SAMPLE HEALTH PLANExplanation of benefits 1
THIS IS NOT A BILL
Member: Jordan Sample · Claim #00000 · Provider: Sample Clinic · Date of service: 02/10 2
| Service | Amount billed | Plan allowed | Plan paid | You may owe 3 |
|---|---|---|---|---|
| Office visit | $250.00 | $140.00 | $112.00 | $28.00 |
| Totals | $250.00 | $140.00 | $112.00 | $28.00 |
Claim status: Processed. If you disagree with this decision, you may appeal 4.
What the numbers mean
- Not a bill. An EOB is a summary from your health plan of the total charges and how much you and the plan will pay (CMS).
- Match it to the bill. Wait for the EOB, then match it to the bill from the doctor or hospital. If they don't match, call your insurance company (MedlinePlus).
- What you may owe. This is the number your bill should match. If the provider bills you more, ask why before you pay.
- Appeal a denial. File an internal appeal within 180 days of a denial notice (HealthCare.gov). Surprise out-of-network bill? The No Surprises Help Desk is 1-800-985-3059 (CMS).
The full lesson: Medical bills and EOBs: check before you pay
Sources
- Centers for Medicare & Medicaid Services Health insurance terms
- MedlinePlus Understanding your hospital bill
- HealthCare.gov Internal appeals
- Centers for Medicare & Medicaid Services No Surprises Act key protections (PDF)