What is an Explanation of Benefits (EOB)?

• A. A bill sent to the patient for services rendered.
• B. An internal memo from the insurer.
• C. A form used to enroll in benefits.
• D. Explanation of benefits; Information that explains the medical claim in detail; also called RA - Remittance Advice.

Answer: (D)

An Explanation of Benefits is a document from the insurance company that shows how a medical claim was processed. It explains, in detail, what the provider billed, what the insurer allowed, what the insurer paid, and what you owe (such as deductible, coinsurance, or copayment). It may also include adjustments and reason codes that tell you why a service was paid differently or denied.

This is not a bill. A bill is what you pay for services. The EOB helps you understand the amounts on a bill and whether anything was covered by insurance. It’s sometimes called Remittance Advice because it accompanies the payment to the provider and explains the payment details.

Other options don’t describe this document: a bill sent to you for services rendered is the charge you owe; an internal memo from the insurer isn’t the patient-facing explanation of how a claim was processed; a form used to enroll in benefits is about enrollment, not claim processing.