How to read an explanation of benefits | CMS

How to read an explanation of benefits (EOB)

See what an explanation of benefits looks like (PDF)

What’s an explanation of benefits?

An explanation of benefits (EOB) shows you the total charges for your visit.

An explanation of benefits isn’t a bill.

It helps you understand how much your health plan covers, and what you’ll pay when you get a bill from your provider.

What’s on an explanation of benefits?

General information about you and your health plan

The explanation of benefits includes information about:

  • You (the patient)
  • Your health plan
  • Who provided your care, and when it was provided
  • A reference number called the claim number
  • The person who gets reimbursed for any overpayments, called the payee

It will also list your health plan’s phone number. Call your health plan if you have questions about finding a provider or what services they cover.

Details about your claim(s)

The explanation of benefits gives you details about your care, like:

  • The date of service
  • A service description. This explains what service you had, like a medical visit, lab test, or screening.

Information about your bill

The explanation of benefits lists the cost of your care, and how much your health insurance company will pay.

  • “Provider Charges” is the amount your provider bills for your visit.
  • “Allowed Charges” is the amount your provider will be paid. This may not be the same as the Provider Charges.
  • “Paid by Insurer” is the amount your health plan will pay to your provider.

What you owe

What You Owe, or Patient Balance, is the amount you owe after your insurer has paid everything else.

You may have already paid for part of the Patient Balance. The Explanation of Benefits only shows what you owe, not if you’ve already paid for it.

Your bill should not be higher than the Patient Balance. If it is, talk to your provider.

Remark code

A remark code is a note from the health plan that explains more about the costs, charges, and paid amounts for your visit.

The code is usually 2 or 3 letters and numbers. Check the bottom of the explanation of benefits for a description of each code.