Explanation of benefits (EOB)

An explanation of benefits (EOB) arrives after a claim is processed. It sets out what was billed, what the plan paid, what was discounted, and what portion may fall to the patient.

It is not a bill. The bill comes separately, from the provider, and paying from an EOB is a common and avoidable error.

What patients ask your team

• Whether they have to pay the amount shown on the EOB.
• Why the provider’s bill differs from what the EOB says they owe.
• What a reason code on a denied claim means.

Why it matters to your program

The EOB is the clearest record of what the plan actually decided: whether a service was applied to the deductible, whether a claim was denied and why, and whether the provider’s later bill matches. It is often the document a support conversation needs before anything else.

How OpenSupport handles it

The assistant explains how to read an EOB and that it is not a bill, with citations. It cannot see the patient’s claims, so questions about a specific statement are deferred to the provider’s billing office and the plan — never answered with an invented amount.