What is an explanation of benefits (EOB) form and its purpose?

• A. A statement from the insurer to the patient detailing what was paid, what was denied, and why.
• B. A bill for patient copay.
• C. A notification of policy cancellation.
• D. A request for medical records.

Answer: (A)

An explanation of benefits is a statement from the insurer after a claim is processed that shows how the claim was handled. It tells you what the insurer paid, what portion was denied or not covered, and the reasons for any denial or adjustment. The purpose is to make the coverage clear: it identifies the allowed amount, any patient responsibility (deductible, coinsurance, or copay), any reductions, and which services weren’t covered. This helps you reconcile a provider bill with the insurer’s payment and decide whether to pay, seek an appeal, or contact the plan for clarification. It’s not a bill for a copay, a cancellation notice, or a request for medical records.