No. An EOB comes from your insurer and explains how a claim was processed. The bill comes from the provider. Wait for the bill, and check it against the EOB before paying.

Why is the allowed amount so much lower than the billed amount?

In-network providers agree prices with insurers in advance. The billed amount is the provider’s list price; the allowed amount is the agreed price, and your share is worked out from it.

What does “patient responsibility” mean on an EOB?

It is the part of the allowed amount the plan did not pay — deductible, copay, coinsurance, or a non-covered service — which the provider can bill you for.

INSURANCE EOB

How to read an explanation of benefits (EOB)

An explanation of benefits (EOB) is the statement your health insurer sends after it processes a claim. It shows what your provider charged, what your plan allowed, what the plan paid, and what may be left for you to pay.

An EOB is not a bill. The bill comes from the doctor, hospital or lab — usually a few weeks later — and the amount on it should match the “you may owe” figure on the EOB. Reading the two side by side is the simplest way to catch a billing mistake.

The parts of an EOB

Claim number: The insurer’s reference for this visit. Quote it whenever you call about the claim.
Service date and provider: When you were seen and who billed for it. Check both are right.
Amount billed (provider charges): The provider’s full list price. Few people with insurance pay this.
Allowed amount: The price your plan has agreed for that service with an in-network provider. Everything else is based on this number, not the billed amount.
Discount or adjustment: The difference between billed and allowed. An in-network provider generally writes this off rather than charging you for it.
Plan paid: What the insurer paid the provider.
Deductible, copay and coinsurance: Your share. The deductible is what you pay before the plan starts sharing costs; a copay is a flat fee; coinsurance is a percentage of the allowed amount.
You may owe (patient responsibility): What the provider can bill you for this claim. Compare it with the bill when it arrives.
Remark or reason codes: Short codes explaining a denial or adjustment, decoded somewhere on the EOB — often on the back or the last page.

A worked example

An invented EOB line for an in-network MRI. Not anyone’s real claim.

On the document	Shows	In plain language
Amount billed	$2,400.00	The imaging centre’s list price.
Allowed amount	$900.00	The plan’s agreed price. The other $1,500 is written off.
Applied to deductible	$500.00	You pay this part first because the deductible was not yet met.
Coinsurance (20%)	$80.00	20% of the remaining $400.
Plan paid	$320.00	80% of the remaining $400.
You may owe	$580.00	$500 deductible + $80 coinsurance. This is what the bill should say.

If the imaging centre later sends a bill for $2,400 — or for anything other than $580 — the EOB is your evidence to ask why.

What to check

Your name, the patient’s name and the service dates are right.
Every service listed is one you actually had.
The provider is shown as in-network if you chose an in-network provider.
Any denial has a reason code, and you understand what it says.
The “you may owe” figure matches the bill from the provider.

Questions worth asking

Ask your insurer

Why was this service denied, and how do I appeal?
How much of my deductible and out-of-pocket maximum is left?
Was this provider processed as in-network?

Ask the provider’s billing office

Has my insurer’s payment been applied to this bill?
Why does the bill differ from the amount on my EOB?
Can I have an itemized bill?

Have an EOB you can’t make sense of? Attach it or take a photo, and Clariti will walk through each line.

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Common questions

Is an EOB a bill?: No. An EOB comes from your insurer and explains how a claim was processed. The bill comes from the provider. Wait for the bill, and check it against the EOB before paying.
Why is the allowed amount so much lower than the billed amount?: In-network providers agree prices with insurers in advance. The billed amount is the provider’s list price; the allowed amount is the agreed price, and your share is worked out from it.
What does “patient responsibility” mean on an EOB?: It is the part of the allowed amount the plan did not pay — deductible, copay, coinsurance, or a non-covered service — which the provider can bill you for.