How Do I Read my EOB (explanation of benefits)?

When you get health care, the doctor, hospital or dentist asks us to pay for the service they provided by submitting a claim.

After we process the claim, you get an explanation of benefits, or EOB. It’s the statement that says This is Not a Bill.

If it’s not a bill, what is it?

EOBs show you the costs associated with the services you received, including:

  • What was billed
  • Any discounts
  • What we pay
  • Total covered
  • What you pay

Since an EOB isn’t a bill, what you pay is for your information only.  If you owe the doctor, hospital or dentist, they’ll send you an invoice. Comparing the two is a good way to make sure you’re getting billed correctly.

Not all claims generate an EOB. For example, you won’t get an EOB for a prescription. Here’s what you can expect to see in your medical EOBs.