What does an Explanation of Benefits (EOB) communicate?

• A. It summarizes the total annual deductible for the patient.
• B. It shows what the plan paid, denied, or patient responsibility, and explains the reason.
• C. It lists all approved procedures in the past year.
• D. It verifies the patient's insurance eligibility.

Answer: (B)

An Explanation of Benefits tells you how a claim was processed by the insurer, showing what the plan paid, what it denied, and what you’re responsible for, with the reason or code for each decision. It’s informational, not a bill, and accompanies any bill you receive so you can see how coverage was applied. Details commonly include the service date and description, the billed charge, the allowed amount, how much the plan paid, any deductible or coinsurance applied, your copay, and the amount you owe, plus explanations for any denial or adjustment. This helps you understand why a charge appears as you see it, what parts of the claim were covered, and whether you should pay, appeal, or contact the insurer.