An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf.[1]

The EOB is commonly attached to a check or statement of electronic payment.

An EOB typically describes:

EOB documents are protected health information.

Electronic EOB documents are called edi 835 5010 files.[2]

There will normally also be at least a brief explanation of any claims that were denied, along with a point to start an appeal.[3]

A member with secondary insurance gives such information to the provider for the next bill to go out to that insurance company. Generally, secondary insurance pays only the amount the EOB says the member is responsible for. Secondary EOBs show if the patient still has any responsibility to the provider. After the member's insurances have processed the claim, the provider bills the member for the remaining balance, if any.[4]


  1. ^ Emblad, Shelley (2018-01-24). "What Is an Explanation of Benefits (EOB) Statement?". The Balance. Retrieved 2018-04-17.
  2. ^ "EDI 835 Health Care Claim Payment/Advice - 835 Transaction Set". 1EDI. Retrieved 2018-04-17.
  3. ^ Runge, Ava; Kennedy, Lynn; Close, Kelly (2017-05-31). "When Insurance Gets Turned Down: Appeals Explained". diaTribe. Retrieved 2018-04-17.
  4. ^ "Understanding an EOB and Your Bill | Medical Business Systems". 2012-01-21. Archived from the original on 2012-02-04. Retrieved 2018-04-17.