How to read an EOB

Your Explanation of Benefits is not a bill — it's the insurer's summary of what your provider charged, what the plan paid, and what you owe. Here's how to read an EOB line by line.

Every field on your EOB, explained

Billed amount (a.k.a. 'charges')

The sticker price the provider sent to the insurer. This is almost always higher than what anyone actually pays. Don't panic at this number.

Allowed amount

The negotiated rate your insurer and the provider agreed on for this service. This is the real price of the care. If you're in-network, you can never be billed more than this.

Plan discount / adjustment

Billed amount minus allowed amount. The provider writes this off as part of the in-network contract. You do not owe this.

Amount paid by insurance

What your insurer sent to the provider after applying your deductible, copay, and coinsurance.

Deductible applied

How much of this claim went toward your annual deductible. Until you hit your deductible, you pay the full allowed amount.

Copay

A flat fee your plan charges for certain visits (often $20–$50 for primary care, more for specialists or the ER).

Coinsurance

Your percentage share after the deductible — commonly 20%. Applies to the allowed amount, not the billed amount.

Patient responsibility (what you owe)

The bottom-line number. Deductible + copay + coinsurance + any denied charges you're responsible for. Compare this to the bill from the provider — they should match.

Denial code / remark code

If any part was denied, look for a short code like CO-45, PR-1, or N130. These codes tell you exactly why the claim was denied — 'not medically necessary,' 'exceeds fee schedule,' 'no prior authorization,' etc. This code is what you need to write a good appeal.

The one-minute EOB check

1. Does the date of service match a visit you actually had?
2. Is the provider in-network? (Check "in-network" or "PAR" flag.)
3. Does "patient responsibility" match the bill the provider sent you? If the provider is billing you MORE than the EOB's patient responsibility for in-network care, that's balance billing and you likely don't owe it.
4. Any denial or remark codes? Those are your appeal starting point.

Educational content — not legal or medical advice. Rules and codes vary by insurer; call the number on your card for questions specific to your plan.