Understand your bills · Lesson 1 of 16
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.
After a visit, you may get two kinds of mail or messages. They look alike, but they do different jobs.
The bill
A bill comes from the place that cared for you, such as a clinic, hospital, or lab. It lists the care, the price, and the amount the provider says you owe. It often has a due date and a way to pay.
The Explanation of Benefits
An Explanation of Benefits (EOB) comes from your health plan after the provider sends a Claim. A claim is the provider's request for payment. The EOB shows:
- what the provider charged,
- the allowed amount, which is the price your plan agreed to,
- what the plan paid, and
- what you may owe, often called "patient responsibility."
Why matching matters
The best time to pay a bill is usually after the EOB arrives. Then you can check that the plan has already paid its part. Look for the same date of service, provider name, and amounts on both.
If the bill asks for more than the EOB says you owe, there may be a simple reason, such as a payment that has not posted yet. It may also be a mistake. Call the provider's billing office and ask them to explain the difference. You can also ask for an itemized bill, which lists each service and charge.
Some bills arrive with no EOB at all. That can happen if the claim was never sent to your plan, or if it is still being processed. Ask the provider whether they billed your insurance.
What can be different for you
Most private plans, Marketplace plans, and Medicare send EOBs or similar notices. Original Medicare calls its notice a Medicare Summary Notice. Medicaid notices vary by state. Many plans post EOBs online instead of mailing them. If you have no insurance, you will not get an EOB.
More detail (optional)
What if I already paid?
If you paid more than your share, ask the provider for a refund of the overpayment. Keep the EOB and your receipt.
What if the EOB shows a denial?
A denied line means the plan did not pay for that service. Read the reason code on the EOB. The lesson "Why was my claim denied?" explains what to do next.
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
Where can I go for help?
Free help is often close by: the member services number on your insurance card, the billing office for your provider, your state insurance department, and nonprofit patient advocates.
This is general education. For decisions about your own plan, taxes, or legal rights, check your plan documents or a qualified professional.