What is an explanation of benefits?
An explanation of benefits shows what your plan was billed for a visit, what it paid, and what portion may be left for you. It is a summary of how a claim was processed, not a bill.
Your plan sends one after it processes a claim from a doctor, hospital, or pharmacy. Getting one simply means a claim tied to your coverage was handled.
Nothing, in most cases. It is informational. It is worth comparing the patient-responsibility amount against any real bill your provider later sends, to make sure they match.
An explanation of benefits is informational. Nothing is due from you because of it, and any real bill would come separately from your provider. This is general information about how these statements work, not a decision about you.
Got one in hand?
Upload your exact letter and we’ll decode it: sender, deadline, and what each question is really asking. If you hold your policies with us, we’ll read it against your real coverage too.
Decode your exact letter, free →This page explains the general pattern of this letter type, cited to how these letters typically read. It is educational only, not legal or claims advice.