After a medical visit — whether for chiropractic care, physical therapy, or treatment after a car accident — you may receive a document from your insurance company called an Explanation of Benefits. It can look complicated. This guide breaks it down so you know exactly what you're looking at and what to do next.
What Is an Explanation of Benefits (EOB)?
An Explanation of Benefits (EOB) is a summary your insurance company sends after processing a claim from your provider. It explains what was billed, what your insurance covered, and what — if anything — you may owe.
In plain terms: it's your insurance company's report card on a claim.
You'll receive an EOB whenever a provider submits a claim on your behalf. That includes chiropractors, physical therapists, orthopedic specialists, and any other provider who bills your insurance.
An EOB Is Not a Bill
This is one of the most common points of confusion. An EOB is not a bill. You do not need to send payment when you receive one.
Your provider's billing department will send you a separate bill if you owe anything after insurance has paid. Always wait for that bill before making a payment — and compare it against your EOB to make sure the numbers match.
Quick rule: EOB = insurance summary. Bill = payment request. They are two separate documents.
How to Read Each Section of Your EOB
EOBs look different depending on your insurance company, but they all contain the same core sections. Here's how to read an EOB from your insurance company, section by section.
{{screenshot: Sample EOB with each section labeled — header, claim details, payment summary, and patient responsibility box}}1. Header / Summary Section
This shows your name, member ID, the date the claim was processed, and the provider who submitted it. Confirm this matches the visit you're expecting to see.
2. Claim Details / Service Lines
This is the most important section. Each line represents one service billed during your visit. You'll see:
- Date of service — the date you were treated
- Procedure code (CPT code) — a number that identifies the specific service
- Billed amount — what your provider charged
- Allowed amount — what your insurance agreed to pay (see glossary below)
- Adjustment / write-off — the difference your provider agreed to accept
- Plan paid — what your insurance actually paid
- Patient responsibility — what you may owe
3. Totals / Summary Box
This rolls up all the service lines into one total. Your patient responsibility total appears here. This is not a bill — it's a projection of what you may owe after insurance.
4. Remark Codes / Denial Reason
If a service was denied or reduced, you'll see a code (like CO-4 or PR-96) and a short explanation. Write this down — you'll need it if you appeal.
Common EOB Terms You Need to Know
Here's a plain-language glossary of the terms you'll see most often.
Allowed Amount The maximum your insurance will pay for a specific service. If your provider charges $150 but the allowed amount is $90, the remaining $60 is written off — you do not owe it. What is the allowed amount on an Explanation of Benefits? It's the negotiated rate between your insurance company and your in-network provider. Billed Amount The full amount your provider charged before any insurance adjustments. Write-Off / Adjustment The portion your provider agreed not to collect because of their contract with your insurer. You are not responsible for this amount. Patient Responsibility What you may owe after insurance pays. This includes your deductible, copay, or coinsurance. Deductible The amount you pay out of pocket each year before your insurance starts covering costs. Coinsurance Your share of costs after your deductible is met — often shown as a percentage (e.g., you pay 20%, insurance pays 80%). CPT Code A five-digit code that identifies a specific medical service or procedure. Insurers use these to process claims. Coordination of Benefits (COB) When you have more than one insurance plan — for example, health insurance and auto insurance after a car accident — COB rules determine which plan pays first. EOB Remark / Denial Code A short code explaining why a claim was denied or adjusted. Common codes appear with a brief description on the EOB.EOBs After a Car Accident or Personal Injury Claim
If you received treatment — chiropractic care, physical therapy, or other injury care — after a car accident, your EOB situation is more complex. Understanding your EOB after a car accident or personal injury claim requires knowing how multiple payers interact.
How Multiple Insurers Are Involved
- Auto insurance (PIP or MedPay) — many auto policies include Personal Injury Protection (PIP) or Medical Payments (MedPay) coverage that pays for treatment regardless of fault
- Health insurance — may be billed as a secondary payer after auto coverage is exhausted
- At-fault driver's liability insurance — typically does not pay providers directly during treatment; settlement comes later
Coordination of Benefits rules determine the payment order. Your provider's billing team manages this, but your EOBs will reflect each payer's portion separately.
Letters of Protection and Attorney Liens
If you're working with a personal injury attorney, your provider may have signed a Letter of Protection (LOP). This means the provider agrees to wait for payment until your case settles. In this situation:
- You may still receive EOBs if health insurance was billed
- The patient responsibility amount on the EOB may not reflect what you actually owe — your attorney and provider will resolve balances at settlement
- Do not pay bills out of pocket without confirming with your attorney first
For more on what to expect after a car accident, see Key Benefits of Choosing Chiropractic Treatment for Car Accident Injuries.
What to Do If Your EOB Shows a Denial or Unexpected Balance
If your insurance denied a claim on your EOB, or your patient responsibility is higher than expected, don't panic. Here's what to do next.
Step 1: Check the Denial or Remark Code
Find the remark code on your EOB and read the explanation. Common reasons include:
- Service requires prior authorization
- Provider is out of network
- Duplicate claim submitted
- Deductible not yet met
- Service not covered under your plan
Step 2: Compare Your EOB to Your Explanation of Coverage (EOC)
Your EOC is the benefits document you received when your plan started. Check whether the denied service is listed as a covered benefit.
Step 3: Contact the Right Party First
See the section below — When to Contact Your Provider or Insurance Company — to decide who to call.
Step 4: Request an Itemized Bill From Your Provider
If your patient responsibility seems higher than expected, ask your provider's billing department for an itemized bill. Compare each line to your EOB. Billing errors are more common than most people realize.
How to Dispute an EOB Error or Appeal a Denied Claim
You have the right to dispute a claim denial or billing error. Here's how to dispute a claim denial on your Explanation of Benefits.
- Gather your documents. Collect your EOB, your provider's itemized bill, your insurance card, and any referral or authorization paperwork.
- Call your insurance company. Use the member services number on the back of your insurance card. Ask for the specific reason for the denial using the remark code on your EOB.
- Ask your provider to resubmit if there's a coding error. If the denial was due to a wrong CPT code or missing information, your provider's billing team can correct and resubmit the claim.
- File a formal appeal. If the denial stands, request the appeals process from your insurer. You typically have 30–180 days to appeal, depending on your plan.
- Submit supporting documentation. Your provider can submit clinical notes, a letter of medical necessity, or other records to support your appeal.
- Request an external review if needed. If your internal appeal is denied, you may have the right to an independent external review under federal law.
If you're receiving chiropractic treatment and need help understanding a denial related to injury care — such as a sciatica diagnosis — your provider's team can often provide documentation to support your appeal.
When to Expect Your EOB — and How Long to Keep It
When Should You Receive Your EOB?
Most insurance companies send an EOB within 7–30 days after processing a claim. Delivery methods vary:
- Mail: 2–4 weeks after your visit
- Online portal / app: Often available within a few days of processing
- Email: If you've opted in to paperless statements
If you haven't received an EOB within 45 days of your visit, log into your insurance member portal or call member services to check the claim status.
How Long Should You Keep Your EOBs?
Keep EOBs for at least one year in most cases. Exceptions:
- Tax purposes: Keep for 3–7 years if you claim medical expenses as a deduction
- Personal injury cases: Keep until your case is fully settled and closed
- Ongoing conditions: Keep for the duration of treatment and one year after
Store digital copies in a secure folder or cloud storage. Shred paper copies when disposal is appropriate.
When to Contact Your Provider or Insurance Company
A common question: Should you call your provider or your insurance company about an EOB error? The answer depends on the type of problem.
Contact Your Provider's Billing Department When:
- The date of service or procedure code looks wrong
- A service you received is missing from the EOB
- You received a bill that doesn't match your EOB
- You need an itemized bill for your records
- You're on a Letter of Protection and received a bill unexpectedly
Contact Your Insurance Company When:
- A covered service was denied
- Your patient responsibility is higher than your plan documents suggest it should be
- You need to understand a remark or denial code
- You want to file a formal appeal
- Your EOB shows a provider as out-of-network when they should be in-network
In many cases, you'll need to loop in both parties. Start with whichever side introduced the error, and keep notes on every call — including the representative's name, date, and what was discussed.
If you're looking for a provider who can help coordinate your care and billing after an injury, finding the right specialist makes the process much smoother from the start.
Still Need Help?
If you have questions about your EOB or need help finding a provider who can assist with billing coordination, our support team is here.
- Search for a provider: Find a provider on Medximity
- Contact support: Reach the Medximity Help Team
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