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A claim is a request for reimbursement typically submitted by your provider for your insurer in anticipation of receiving payment for their services.

An explanation of benefit (EOB) is a documentation of a claim and the allocation of financial responsibility for that claim sent to you by your insurance company. An EOB is specific to a provider and the service(s) rendered by that provider. The format varies widely between insurers, but at a minimum should indicate the provider, service date, actual billed amount, network discount, allowed amount, insurance portion, patient responsibility, and deductible amount.

A statement is a summary of bills outstanding with a provider. While it can be easy to confuse a statement with a bill, statements are generally clearly marked somewhere with the word “statement” and usually do not carry the same level of detail as a bill.

The Billed Amount is the amount your provider charged. The Allowed Amount is the amount that they have agreed to accept based on a contractual agreement with you or your insurer.

The EOB (Explanation of Benefit) sent by your insurance company details the provider payment and how much you may still owe… or that your claim has been denied! Be sure to review the paperwork to understand why the claim has been denied. Typically, there will be a “Reason Code(s)” and explanation listed on the EOB.