Room · Health bills & EOB
A bill, an EOB, a letter. What's what?
EOB means "Explanation of Benefits". It isn't a bill. Here is how to read it next to the bill.
Situations that come up a lot
ER visit
Several bills can follow one visit. Match each to its own line on the EOB.
Out-of-network bill
The plan may pay less. Look for the page that explains out-of-network rules.
Lab or imaging
Often billed separately from the doctor. Check each one.
A denial letter
Start with the code, then the appeal window.
Questions people ask here
What is an EOB?
A statement from your plan about a claim: what was billed, what it paid, what is left for you.
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Why was my claim denied?
The letter has a short code that says why. Look it up in the code dictionary, then check the date. It tells you how long you have to ask for another look.
How long do I have to appeal?
The window is on your letter. Many plans use a window of a few months, so check yours.
What is balance billing?
When a provider bills you for the difference between what they charged and what the plan paid. Ask the plan and the provider why.
Is an EOB a bill?
No. An EOB explains a claim. A bill comes from the provider. Read them side by side.
In-network or out?
In-network providers have an agreement with your plan. Out-of-network ones may cost you more.
Papers to gather
- EOB or denial letter
- Itemized bill from the provider
- Records, only if asked
- Provider name and address
- Member ID
- Your notes on dates and calls
A deadline, as an example
Your dates are in your own policy and letters.
Example
Day 0
Date on the EOB.
Day 60–180
Many plans use a window of 60–180 days for appeals. Check your policy page.
Your letter
The date on your letter is the one that counts.