What is provided in an Explanation of Benefits?

An Explanation of Benefits (EOB) primarily serves as a communication tool from the insurance company to the insured individual after a claim has been processed. It outlines the financial aspects of a medical claim, indicating how much of the claim was covered by the insurance provider, the amount that the insured is responsible for, and any adjustments made during the claims process. This document breaks down specific services provided, the costs associated with those services, the insurance company’s payment, and any remaining balance that the insured must pay, thereby clarifying how the benefits were determined.

While other options touch on aspects of insurance and healthcare documents, they do not capture the essence of what an EOB provides. For instance, a summary of coverage details pertains more to the terms of a policy, not individual claims. Legal documents that outline patient rights focus on patient advocacy rather than financial transactions. A detailed bill for services, while it may contain payment information, is fundamentally different from an EOB because it does not explain the insurer's role in those payments or the rationale behind the amounts paid or owed. Hence, the description of an EOB as a document indicating amounts paid and how benefits were determined is accurate and encapsulates its function effectively.