What’s an EOB (and What Should You Do If You Get One)?

Of all the medical abbreviations, “EOB” is a common one. It stands for explanation of benefits. This is a document that arrives in the mail or to your secure online account that shows how you split your care costs with your health plan. It details how much money you may have to pay out of pocket for the services you receive.

You’ll only get an EOB from your health plan after you’ve had a medical service or bought equipment using your insurance card. An EOB is not a bill, but it details what to expect when you receive the bill or bills.

Below, we answer common questions about EOBs and explain how you can use them to find errors and resolve issues with your care team or health plan.

What does an EOB statement look like?

EOBs don’t have a universal presentation. Their layout varies by insurer. But most EOBs include standard information like contact details and clarification that it isn’t a bill.

EOBs typically also show two to three tables displaying medical service costs, insurance coverage, and any expenses you need to pay. They show you the mathematical breakdown of how the insurer arrived at your out-of-pocket costs. Some EOBs use color contrast in their designs to better differentiate the portions that need closer attention.

Your health plan may reserve space on its EOB for definitions of common but confusing insurance terms such as deductible, copay, and coinsurance. Some health plans also include preventive care reminders.

Health insurers typically send EOBs to the person who pays the insurance premiums. But EOBs often include cost and coverage information about all the insured members in a household. So some states have rules protecting the healthcare privacy of people insured as dependents for sensitive services.

People with different kinds of insurance get different kinds of EOBs or healthcare statements. For example, if you have original Medicare, you get what’s called a Medicare summary notice every 3 months if you use healthcare services.

If you’re a Medicare enrollee with a private Part D or Medicare Advantage plan, you get EOBs instead. You may receive your EOBs monthly or per claim, in the mail or online.

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What’s included in the EOB document?

The EOB is an overview of medical services you received. It explains the calculation of your benefits. Here is what you’ll typically find on your EOB:

1. Account summary — A brief snapshot of vital information, including:

• Your name and address

• Health plan member’s ID and group number

2. Details of the service — A description of the medical services you received, including:

• Name of the service given

• Provider name

• Location and date of the service

• A document reference number

• Sometimes medical codes 

3. Cost breakdown — The amount of the claim and how you and your insurer share the costs, including: 

• Amount billed: The amount of money your provider and/or the facility charged for the medical service

• Allowed amount: How much the insurer can reimburse the provider

• Paid amount: The amount your insurer actually paid the provider

• Patient’s responsibility: Your share of charges, such as the copay or coinsurance you paid or may still owe (for an office visit or lab fees, for example)

• Remark code, reason code, or notes section: Where your insurer explains more about an individual line item

4. Additional information, including:

• Services not covered, if any

• A glossary to clarify terms used in the EOB

• State-specific directions on filing a grievance or appealing a claim

• Information on how to get translations in multiple languages

• Summary of year-to-date deductibles (You may have one each for in-network and out-of-network) and out-of-pocket maximums

When should you receive an EOB?

It’s not uncommon for an EOB to arrive within 30 to 60 days of receiving a medical service. If you don’t receive one after 60 days, call your health plan.

In some cases, it can take a long time between when you get an EOB and when you get an actual bill. Some states have responded to long delays by setting legal limits on medical billing times, as explained below.

You may not receive an EOB if you have a Medicare Advantage plan and:

• You haven’t had a claim (gotten a healthcare service or item) during a reporting period

• You are dually enrolled in Medicare and Medicaid

What should you do with an EOB?

You should review the EOB to:

• Check that services are listed correctly and covered according to your plan benefits

• Compare the EOB to its corresponding medical bills, receipts, or statements to confirm that all the charges match — and to make sure you aren’t double-billed or billed for a service you didn’t receive

• Check progress on your deductible and out-of-pocket maximum spending to date

Also, ensure you’re not overpaying for services protected under the No Surprises Act. If you have private health coverage, the act protects you from surprise medical bills after January 1, 2022, resulting from:

• Most emergency services

• Nonemergency and balance bills from out-of-network providers at in-network facilities

• Out-of-network air ambulance providers

The No Surprises Act is supposed to prevent you from getting shockingly high bills due to the above circumstances. If you’ve experienced any of these scenarios, check your EOBs to make sure your health plan did, in fact, cover the services at in-network rates. Otherwise, the EOB may show you as responsible for higher out-of-network payments. (Note that ground ambulance charges are excluded from the No Surprises Act.)

For surprise billing and other possible errors on an EOB, there are steps you can take:

• Call the provider to let them know about the issue. It could be a coding or human error. For example, the EOB may mistakenly show that you need to pay for a COVID vaccine or covered preventative care. These costs should be free. Informing providers of this may be an easy fix.

• If the provider or insurer doesn't correct the EOB, you can file an appeal. 

• The No Surprises Act established a new process called independent dispute resolution for certain out-of-network charges.

What happens if you receive an EOB but no bill?

Check the area on your EOB that shows the allowed charges and compare it to the amount paid by your insurer. If the amount you owe is zero, your health insurance may have covered the entire cost.

First, call your healthcare provider’s customer service number if you see a balance but haven't gotten a bill. If your health insurer is also your provider, you can find this number on your health insurer's member ID card.

If you have Medicare and are missing a bill from a Part A or Part B provider that appeared as a charge on your Medicare summary notice, you can call 1-800-MEDICARE (1-800-633-4227). If you have a missing bill and an EOB from a Medicare Advantage or Medicare Part D plan, call the plan directly.

In some places, an extensive lag time between getting an EOB and the corresponding medical bill means that you may not have to pay much of the missing bill at all. That’s because some states have laws enforcing medical billing time limits. In Texas, for example, healthcare providers have to waive most patient charges if they don’t bill within 11 months of providing the service. It’s part of a move toward reining in medical debt.

How long should you keep EOB documents?

There isn’t a formal rule, but it may help to follow healthcare provider practices — especially if you receive care for an ongoing medical condition or have complex billing. For example, the Florida Board of Medicine requires providers to hold medical records for at least 5 years. 

Meanwhile, the IRS recommends keeping records at least 3 years for tax purposes. This may apply to you if you take a medical expense tax deduction.

If you aren’t receiving treatment for a chronic medical condition, you may want to shred and discard EOBs after one year. If you have an online account with your health plan, you can likely go paperless and access your past EOBs digitally, or you can scan and save them to your personal computer or smartphone to reduce paper. You also can request a copy of a missing EOB from your insurer.

States like New York and Wisconsin only send an EOB if there’s a balance due. So, a fully covered service like preventative care wouldn’t trigger an EOB. If you live in a state where you may get an EOB for a free flu shot that you’ve had, you might feel justified in shredding that EOB once you feel there’s no chance of getting a bill by mistake.

When you’re done with an EOB, don’t just recycle it or throw it in the trash. EOBs contain personally identifiable information, so it’s best to shred them to prevent fraud and identity theft.

Can you appeal the claim filed in an EOB?

Yes. If you have a health plan through the Affordable Care Act marketplace and the insurer denies the claim, you'll have 180 days or 6 months to file an internal appeal. 

The insurer should complete the internal appeal process in:

• 60 days, for care you've already received

• 30 days, for services you haven't yet received

• For a faster decision for an urgent medical condition, you can request an external review.

If your health plan denies the appeal, it must explain why within 30 days of the medical care you've already received.

If you have private insurance, you can typically initiate an appeal in writing and send it by mail, fax, or sometimes online. You usually have 180 days from when you received the EOB to appeal. The timeline for submitting an appeal can vary by state or the agreement you have with your insurer.

You can either fill out a member appeal form or write a letter. Call your health insurer’s member services department for more guidance on initiating an appeal.

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Written by:

Chanell Alexander, MBA

Chanell Alexander is a freelance personal finance writer and editor. She has written about the intersection of personal finance and health and has worked with nonprofits to develop personal finance programming for underserved populations.

Edited by:

Kristen Gerencher, MSOT

Kristen Gerencher, MSOT, is an award-winning writer who's reported on healthcare, medicine, and insurance for various national outlets. Before contributing to GoodRx, she was a healthcare and personal finance reporter for MarketWatch.

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