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Answer

Is this a bill or an Explanation of Benefits?

The short answer

A bill comes from the doctor, hospital, or lab and asks you to pay. An Explanation of Benefits (EOB) comes from your health plan and shows what it paid. An EOB is not a bill. Compare both before you pay.

Key takeaways

  • An EOB usually says "This is not a bill." It shows what your plan paid and what you may owe.
  • The amount you owe on the bill should usually match "patient responsibility" on the EOB.
  • If the numbers do not match, ask questions before you pay.

What you can do next

  1. Find the EOB for the same date of service, in the mail or your plan's website.
  2. Compare "patient responsibility" on the EOB with the amount due on the bill.
  3. If they differ, call the billing office and ask why before you pay.

Read the full lesson

Words in this lesson

Explanation of Benefits (EOB)
A statement from your health plan showing what was charged, what the plan paid, and what you may owe. It is not a bill.
Claim
A request for payment sent to your health plan, usually by your provider, after you get care.
Allowed amount
The price your plan agrees to pay for a covered service. Your share is based on this amount, not the provider's full charge.
Itemized bill
A detailed bill that lists each service, supply, date, and charge. You can ask your provider for one.

Related

This is general education. For decisions about your own plan, taxes, or legal rights, check your plan documents or a qualified professional.

Sources

  1. Medical bill rights (No Surprises Act protections) Centers for Medicare & Medicaid Services. Applies to: current page. Published or updated: Unknown. Retrieved: .
  2. Summary of Benefits and Coverage HealthCare.gov (Centers for Medicare & Medicaid Services). Applies to: current page. Published or updated: Unknown. Retrieved: .