Read an EOB and bill
Below is a made-up Explanation of Benefits and the matching bill for the same visit. Select a numbered marker to learn what that part means. A full text version follows the documents.
Fictional documents for learning. Not a real person, clinic, or plan.
Example Health Plan
Explanation of Benefits
THIS IS NOT A BILL
| Service | Amount billed | Allowed amount | Applied to deductible | Copay | Plan paid | Your responsibility |
|---|---|---|---|---|---|---|
| Office visit | $250 | $150 | $0 | $30 | $120 | $30 |
| Blood test | $180 | $90 | $90 | $0 | $0 | $90 |
| Totals | $430 | $240 | $90 | $30 | $120 | $120 |
Remark: PR-1 Amount applied to your deductible.
Lakeside Family Clinic
Patient statement
- Total charges
- $430
- Insurance payment
- −$120
- Insurance adjustment
- −$190
- Amount due
- $120
Please pay by: October 30, 2026
Text version of all explanations
- Not a bill. An EOB comes from your plan. It explains how a claim was processed. Do not pay from the EOB; wait for the provider's bill and compare.
- Amount billed. The provider's full price. Most insured patients do not pay this amount, because the plan has a lower agreed price.
- Allowed amount. The price your plan agreed to with in-network providers. Your share is figured from this number. Here: $150 + $90 = $240.
- Applied to deductible. The $90 blood test went toward Alex's deductible, so the plan paid $0 for it. Alex pays the $90.
- Plan paid. What the plan paid the clinic. The office visit: $150 allowed minus a $30 copay = $120 paid.
- Your responsibility. The most you should owe for this claim: $30 copay + $90 deductible = $120. Compare this with the bill.
- Insurance payment. This should match "Plan paid" on the EOB: $120. If the bill shows no insurance payment, ask whether the claim was sent.
- Insurance adjustment. The part of the price the clinic removes because of its contract with the plan: $430 billed minus $240 allowed = $190.
- Amount due. $430 − $120 − $190 = $120. This matches "Your responsibility" on the EOB, so the bill looks consistent.
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.