Question 1

What is an Explanation of Benefits (EOB)?

Accepted Answer

An Explanation of Benefits (EOB) is a statement from your insurance company that shows what medical services were billed, how much your insurance covered, and what you may owe. It is not a bill — it's a summary of how your claim was processed.

Question 2

What is the difference between the billed amount and the allowed amount on an EOB?

Accepted Answer

The billed amount is the full price your healthcare provider charged for a service. The allowed amount is the maximum your insurance company has agreed to pay based on their negotiated rate. The difference between these two is typically written off by the provider — you don't owe that portion.

Question 3

Why does my EOB show a different amount than my medical bill?

Accepted Answer

Your EOB shows the insurance company's processing of the claim, including negotiated discounts and adjustments. Your medical bill from the provider shows the remaining balance you owe after insurance payments. The EOB amount and bill should align, but if they don't, contact your insurance company.

Question 4

What should I do if my insurance claim is denied?

Accepted Answer

If your claim is denied, don't panic. First, review the denial reason code on your EOB. Common reasons include missing prior authorization, out-of-network providers, or coding errors. You have the right to appeal — and about 50% of appeals are successful. File your appeal within 180 days of the denial.

Question 5

How do I know if I'm being balance billed illegally?

Accepted Answer

Under the No Surprises Act, in-network providers cannot bill you more than the allowed amount. If you receive a bill for the difference between the billed and allowed amounts from an in-network provider, this may be illegal balance billing. Out-of-network emergency services are also protected. Check your EOB and compare it to your bill.

Question 6

How does the EOB Decoder tool work?

Accepted Answer

Our EOB Decoder lets you upload a photo of your EOB or manually enter the key fields (billed amount, allowed amount, insurance paid, your responsibility, etc.). It then translates everything into plain English, creates a visual breakdown of costs, flags potential issues like overcharging or balance billing, and suggests next steps.

📋 EOB Decoder