What Is an EOB and Why Is It Important?

If you’ve ever visited a doctor, filled a prescription, or had a medical procedure, chances are you’ve received an Explanation of Benefits (EOB). But many people either ignore it or mistake it for a bill—and that can lead to unnecessary stress or payment mistakes.

So, what is an EOB?

An Explanation of Benefits is a statement from your health insurance provider that outlines:

• What services were billed by the provider

• How much the provider charged

• What your insurance paid toward the claim

• What adjustments or discounts were applied

• What (if anything) you may still owe

  
  

It’s important to understand that an EOB is not a bill. It’s a detailed snapshot of how your claim was processed.

Why Is Your EOB So Important?

1. It Protects You from Overpaying Sometimes providers send a bill before insurance has processed the claim—or worse, bill you for an amount already paid by insurance. Your EOB shows the true breakdown, so you can:

• Compare the bill to your EOB

• Confirm any balance due

• Challenge any overcharges or mistakes

  
  

2. It Helps You Track Your Benefits Your EOB includes key information about your current benefits usage, such as:

• How much of your deductible has been met

• Your current out-of-pocket maximum status

• How many visits or services you've used (especially for limited benefits like PT or chiropractic care)

  
  

3. It Identifies Billing Errors or Fraud By reviewing your EOB, you may catch:

• Duplicate charges

• Services you didn’t receive

• Incorrect coding or out-of-network pricing errors

  
  

If something looks off, call your insurance provider—or reach out to your benefits advocate (that’s us!) to help you sort it out.

4. It Guides You on What to Pay (and When) Let’s say you get a medical bill in the mail. Before you pay:

• Pull your EOB for that date of service

• Confirm that the services and billed amounts match

• Only pay after insurance has processed the claim

  
  

This process ensures you’re not overpaying or paying for services that should be covered.

5. It Supports Reimbursement Claims If you’re submitting a claim for reimbursement from an HRA or FSA, your EOB is often required to:

• Prove the service date and type

• Show what insurance paid and what you owe

  
  

Always keep your EOBs on file until the claim is fully resolved.

What Should You Do With Your EOBs?

• Read them carefully when they arrive (usually by mail or in your online member portal)

• Match them with any bills you receive

• Keep digital or paper copies in a safe place

• Ask questions if anything is unclear

  
  

At S+H Benefit Solutions, we know how confusing this all can be. That’s why we’re here to guide you through the fine print—so you can focus on your health, not the paperwork.

When in doubt, send it to us. We’ll help break it down.