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What’s on an explanation of benefits?
General information about you and your health plan
The explanation of benefits includes information about:

You (the patient)
Your health plan
Who provided your care, and when it was provided
A reference number called the claim number
The person who gets reimbursed for any overpayments, called the payee
It will also list your health plan’s phone number. Call your health plan if you have questions about finding a provider or what services they cover.

Details about your claim(s)
The explanation of benefits gives you details about your care, like:

The date of service
A service description. This explains what service you had, like a medical visit, lab test, or screening.

Information about your bill
The explanation of benefits lists the cost of your care, and how much your health insurance company will pay.

“Provider Charges” is the amount your provider bills for your visit.
“Allowed Charges” is the amount your provider will be paid. This may not be the same as the Provider Charges.
“Paid by Insurer” is the amount your health plan will pay to your provider.

What you owe
What You Owe, or Patient Balance, is the amount you owe after your insurer has paid everything else.

You may have already paid for part of the Patient Balance. The Explanation of Benefits only shows what you owe, not if you’ve already paid for it.

Your bill should not be higher than the Patient Balance. If it is, talk to your provider.

Remark code
A remark code is a note from the health plan that explains more about the costs, charges, and paid amounts for your visit.

The code is usually 2 or 3 letters and numbers. Check the bottom of the explanation of benefits for a description of each code.

https://www.cms.gov/medical-bill-rights/help/guides/explanation-of-benefits

Explanation of Benefits. The hospital/Doctor’s office will send you a bill right after your procedure/Dr. Visit, where the Insurance has not been approved (yet), so it appears that the Insurance has been denied. The EOB lists each charge, and how much the Medical paid, How much the Insurance paid, and how much you are charged. Many times we have seen the actual coding number has been the wrong number, which means that it won’t be paid. Unfortunately, you are the one who has to make sure they have the correct code for each entity. How many old people (like me) have just paid the initial bill and trusting the billers is probably staggering. The Medicals are glad to get paid regardless of who pays it, you or insurance. The con is that they charge enormous costs for each event, and then the Insurance company denies most of it, which the medical folks write off. If you did not have insurance, you would be responsible for all of the original bill. For instance, last year my gross medical costs were in the millions, but insurance denied most of it, and I paid what remained, which remained several thousand dollars, but not the millions that were written off.