An EOB is generated by the insurance carrier, and is sent by the insurance company. It is a statement to covered individuals (aka: policy holders) explaining what treatments and/or services were paid for on their behalf.
The EOB is commonly attached to a check or statement of electronic payment.
An EOB typically describes:
- the payee, the payer, and the patient
- the service performed:
- the date of the service
- the description and/or the insurer's code for the service
- the name of the person or place which provided the service
- the name of the patient
- the office's fee, and what the insurer allows— that is, the amount initially claimed by the doctor or hospital, minus any reductions applied by the insurer
- the amount the patient is responsible for paying
- adjustment reasons via adjustment codes
EOB documents are protected health information.
Electronic EOB documents are called edit 835 5010 files.
There normally also will be at least a brief explanation of any claims that were denied, along with a point to start an appeal.