Same number, different names: an EOB field translator

One reason EOBs are hard to read is that every insurer labels the same numbers differently. The allowed amount on one statement is the eligible amount on another and the approved amount on a third. This translator lists the common names for each figure and what to do with it.

On the Explanation of Benefits

• Billed. Also called charges, amount charged, submitted or total charges. This is the provider's list price. Note it, then set it aside, because for in network care it isn't the real price.
• Allowed. Also called eligible, negotiated, approved or plan allowance. This is the real price, and every percentage in your plan is calculated from it.
• Network discount. Also called contractual adjustment, write-off, provider discount, plan discount or savings. Make sure it never shows up in the amount you are asked to pay.
• Plan paid. Also called paid by plan, insurance payment or benefit amount. Use it to check that the allowed amount equals what the plan paid plus your share.
• Your share. Also called patient responsibility, member responsibility, you owe or amount you may be billed. For in network care, compare every bill against this figure.
• Deductible. Also called applied to deductible or deductible amount. Add these up across the year and compare the total with your insurer's figure.
• Copay. Also called copayment or office visit charge. Check the amount, and what it is charged per, against your plan.
• Coinsurance. Also called member coinsurance or your percentage. Divide it by the allowed amount to see the rate you were actually charged.
• Not covered. Also called non-covered, disallowed or excluded. Ask why, in writing. It usually doesn't count toward your caps.
• Remarks. Also called remark codes, reason codes, notes or message codes. Read every one. This is where the insurer explains its decision.

Identifiers and dates

• Claim number. Also called reference number or document control number. This is your key for matching a bill to the right claim, so write it on the bill.
• Account number. Also called patient account or guarantor account. This connects the provider's bills and your receipts to each other.
• Date of service. Also called service date, or from and to dates. This is the date that matters for every check, and the one to quote when you write to anyone.
• Year to date totals. Also called deductible met, out-of-pocket met or accumulators. Compare them with your own total across your EOBs. If yours is higher, the insurer's total may be missing a claim.

Labels vary between insurers and change over time. If a figure on your EOB doesn't appear here, look at how it is calculated rather than what it is called.

General information, not legal, medical or financial advice. Every plan is different, so check the details against your own plan documents.