What is an explanation of benefits (EOB)?

An explanation of benefits (EOB) is a statement issued by an insurance company that provides detailed information about the medical services billed by a provider. It outlines the specific services rendered, indicating which services were covered by the insurance policy, the amount the insurance company has paid, and any adjustments made to the billed amount. Additionally, the EOB specifies any amounts that may be the patient's responsibility, such as deductibles, copayments, or coinsurance.

This document serves an important function for both patients and healthcare providers by transparently displaying how claims are processed and what the financial responsibilities will be. Thus, understanding the EOB is crucial for effective billing and patient financial communication.

The other options do not accurately define an EOB: a summary of patient demographics is not relevant to the financial transaction; a legal document requirement is not specific to EOBs; and a report on health services, while related to patient care, does not encompass the billing and payment details provided in an explanation of benefits.