What is an Explanation of Benefits?

• A. End of Billing
• B. Explanation of Benefits
• C. Estimated Outlay Balance
• D. Employee Ownership Benefit

Answer: (B)

An Explanation of Benefits is a document from a health insurer that explains how a claim was processed and what the patient owes. It breaks down the services billed, the insurer’s allowed amount, how much the insurer paid, and the patient’s remaining responsibility after applying any deductible, copay, or coinsurance. It also shows whether the service was covered and may include reasons if a claim was denied or if a provider is out of network. The EOB helps you understand why a bill looks the way it does, verify accuracy, and decide whether to pay, appeal, or discuss with the provider. Note that an Explanation of Benefits is not a bill, though a bill may follow.