Definition
Explanation of Benefits (EOB)
A document from your insurer explaining how a claim was processed and what was paid or denied.
An Explanation of Benefits (EOB) is a statement sent by your health insurer after you receive care. It details what services were billed, what the insurer paid, what adjustments were made, and — critically — your denial reason code (CARC code) and any patient responsibility. The EOB is not a bill. It is the starting point for any insurance appeal: the denial code on your EOB tells you exactly which federal regulations apply to your situation and whether your denial is patient-appealable.
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