A claim appears in your health plan’s online account, followed by a statement showing an amount you may owe. That document is often an Explanation of Benefits, or EOB—not a request for payment. Knowing what it does and does not tell you can make the next step much clearer.
What the statement explains
An EOB summarizes how your insurer processed a healthcare claim. It may show the provider’s charge, the amount the plan recognizes for the service, what the plan paid, and what the plan says may be your responsibility. The terms and layout vary, so use the definitions on your own statement.
Why it is not a bill
The EOB comes from the health plan to explain claim processing; a bill comes from the provider asking for payment. The provider may bill you later, and the amount should be compared with the EOB rather than assumed from it. If the claim is still being processed or the statement says no payment is due, check its status before acting.
Compare before you pay
Check that the provider, service date, and listed service match your visit, then look for the claim status and the patient-responsibility amount. When a provider bill arrives, compare its details with the EOB and contact the provider’s billing office about differences. For questions about how the plan applied your benefits, ask the insurer; what you owe can depend on the specific policy and claim.