What does "explanation of benefits" (EOB) entail?

The concept of "explanation of benefits" (EOB) refers to a detailed document provided by health insurers that outlines the services a policyholder received, indicating which of those services are covered under the insurance plan. It includes information on how much the insurer paid, any amounts that the insured may still owe, and any adjustments that were made during the processing of the claim. This document is crucial for policyholders as it provides transparency regarding their benefits and costs, helping them to understand what portion of their medical expenses will be taken care of by the insurance company versus what they are responsible for.

The EOB is an essential tool for policyholders to track their health care spending and manage their financial responsibilities effectively. It also often contains information about how to appeal a claim if a certain service was not covered, thus aiding the insured in navigating their insurance benefits further.