Medical
Explanation of Benefits (EOB)
An Explanation of Benefits (EOB) is a statement your health insurer sends after processing a medical claim. It shows what the provider billed, the allowed (negotiated) amount, what the plan paid, and the amount you owe. An EOB is not a bill — it explains how your claim was adjudicated.
An EOB is not a bill — per CMS, you should typically receive an Explanation of Benefits from your health plan before you get a medical bill from your provider's office.
Written & maintained by the Granite team · Last updated June 2026
Overview
Your insurer issues an EOB after a provider files a claim for your care. It reconciles three numbers: the amount billed, the amount the plan paid, and your patient responsibility (copay, coinsurance, and anything applied to your deductible). The provider then sends a separate bill for that responsibility. Per CMS, you should typically receive the EOB from your health plan before the medical bill arrives from your provider.
EOBs are the tool for catching billing errors and tracking your deductible. Comparing the EOB to the provider's bill — making sure the "you owe" figures match — is how you spot overcharges and duplicate claims before you pay.
When you’ll get your Explanation of Benefits (EOB)
- You had a doctor visit, procedure, lab, or hospital stay
- Your insurer processed a claim from a provider
- You filled a prescription covered by your plan
- You're tracking spending against your deductible or out-of-pocket max
- You need to verify a provider's bill matches what insurance says you owe
What’s on your Explanation of Benefits (EOB)
These are the fields Granite reads and extracts automatically the moment you upload one.
- Carrier
- The insurance company that issued the EOB.
- Claim Number
- The insurer's identifier for this claim (sensitive).
- Service Date
- The date of care, often different from the EOB's issue date.
- Total Billed
- What the provider charged for the service (provider charges).
- Plan Paid
- The amount your insurance paid the provider.
- Patient Responsibility
- What you owe after the plan paid — copay, coinsurance, and deductible.
How long to keep it
Keep EOBs at least 1 year after the matching bill is paid and reconciled; keep them 5+ years if the care relates to an ongoing claim, HSA reimbursement, or tax deduction.
An EOB is your proof of how a claim was paid and what you actually owed. You need it to dispute a wrong bill, substantiate an HSA/FSA withdrawal, or claim a medical deduction — and disputes and audits can arrive long after the visit, so don't toss the EOB the moment the bill clears.
How Granite handles your Explanation of Benefits (EOB)
Granite reads each EOB — carrier, claim number, service date, billed, plan-paid, and patient responsibility — and files it with your medical records. Because it captures the patient-responsibility figure, you can match the EOB against the provider's bill in seconds to catch overcharges, and your full claim history for a treatment is gathered in one place when a dispute or HSA reimbursement comes up.
FAQ
Explanation of Benefits (EOB): common questions
- What is an Explanation of Benefits (EOB)?
- An EOB is a statement your health insurer sends after processing a claim. It shows what the provider billed, the allowed amount, what the plan paid, and your patient responsibility. It explains how your claim was handled — it is not a bill, and you shouldn't pay from it. The provider sends a separate bill for what you owe.
- Why is an EOB not a bill?
- An EOB is the insurer's report of how it processed your claim, not a request for payment. It shows the cost of services and how those costs are shared between you and your plan. If there's an amount you owe, your provider sends a separate bill for that portion. CMS notes you usually get the EOB before the provider's bill arrives.
- Who sends an EOB?
- Your health insurance company sends the EOB, not your doctor or hospital. After you receive care, the provider files a claim with your insurer; the insurer applies your plan benefits and mails or posts an EOB explaining how the costs of services are shared between you and the plan. The provider then bills you separately for any patient responsibility.
- How do I get an EOB?
- You don't request an EOB — it's generated automatically when a claim is processed. After your provider files a claim, your insurer reviews it, applies your benefits, and sends an EOB by mail or to your online member portal. Most insurers keep recent EOBs available to download from your account, so you can pull one anytime.
- How long should I keep an Explanation of Benefits?
- Keep an EOB at least a year after the matching bill is paid and reconciled. Keep it five years or more if it relates to ongoing treatment, an HSA/FSA reimbursement, or a medical tax deduction — situations where you may need to prove what was paid well after the date of service.
Sources
This page is checked against primary and authoritative sources:
Keep your Explanation of Benefits (EOB) in one place.
Drop it in once. Granite reads it, files it, and makes it findable forever — by you today, and by the people who'll need it later.