Understanding Your Explanation of Benefits (EOB). By Nicole Hollowell, Revenue Cycle Director

Understanding Your Explanation of Benefits (EOB)
Nicole Hollowell, Revenue Cycle Director

After you’ve received medical care and your insurance has processed the claim, you’ll get a document in the mail or through your online insurance portal called an Explanation of Benefits, or EOB. While it might look like a bill at first glance, don’t worry—an EOB is not a bill. It’s a summary that helps you understand how your insurance claim was handled.

Let’s break down what you’ll typically find on an EOB and what each part means:

Patient & Service Information

This section confirms basic details, including:

  • Your name
  • The date of service
  • The provider or facility where you received care

Details of Services

Here, you’ll see a line-by-line breakdown of the medical services or procedures you received. Each item may be listed with a specific code representing a particular test, treatment, or visit.

Amount Charged

This is the full amount your healthcare provider billed for the services.

Allowed Amount

Your insurance company has a contracted rate with your provider. The allowed amount is what your insurance agrees the service should cost, which is often less than the full amount charged.

Amount Covered by Insurance

This number shows how much your insurance actually paid toward your care.

Amount You Owe

This is what you may still need to pay, and it might include:

(If there is an amount owed you will receive a statement from Pershing Health System after the insurance has fully processed)

  • Your deductible
  • A co-pay
  • Coinsurance
  • Any portion for non-covered services

Adjustments

These are reductions or discounts based on agreements between your insurance company and the healthcare provider. You might see these listed as “provider adjustments” or similar terms.

A Quick Reminder:

  • An EOB is not a bill. It’s for your information only.
  • Review it carefully. If something doesn’t look right, or if you have questions about what you owe, we’re here to help.

Reach out to the Financial Resources Department at Pershing Health System at 660-258-1197 or 660-258-1198. We’re happy to walk you through your EOB and answer any billing questions.