How to Read and Explanation of Benefits (EOB)

Reading an Explanation of Benefits (EOB) can be tricky. It almost seems like they are specially formatted to be confusing.

That's because they are.

Insurance companies didn't accidentally create the most incomprehensible document in healthcare. They built EOBs to be confusing on purpose—so you'll miss underpayments, overlook denials, and give up trying to fight back. The harder it is to read, the more money stays in their pocket instead of yours.

But here's the thing: once you know what you're looking at, their game falls apart. Let's break down exactly where they hide their BS.

What the Hell is an EOB Anyway?

An Explanation of Benefits (EOB) is supposedly a document that "explains" how an insurance company processed your claim. In reality, it's a maze of codes, contradictory numbers, and mysterious fees designed to make your eyes glaze over.

But buried in all that noise is the truth about whether you're getting paid correctly—or getting screwed.

The 7 Places Insurance Companies Hide Their Tricks

Here's what you actually need to look at (and why):

1. Provider Information Yeah, it's just your name and practice info. But double-check it—wrong provider information is insurance companies' favorite excuse to deny or delay payment.

2. Dates of Service Seems simple, right? Wrong. Mismatched dates are how claims mysteriously "don't match our records." Always verify these match your actual service dates.

3. Codes (CPT/Procedure Codes) This is where it gets fun. Insurance companies love to "accidentally" process the wrong code—conveniently, always one that pays less. If you billed 99214 but they paid for 99213, congrats: you just lost money.

4. Charges What you billed. Straightforward enough—until you compare it to...

5. Allowed Amount Here's where the scam really kicks in. This is what insurance "allows" them to pay, regardless of what you charged. And somehow, magically, it's always lower than your fee. Even worse? This number can change without warning, and good luck getting an explanation why.

6. Paid Amount What they actually sent you. Now compare this to the "allowed amount." See a difference? That's money they kept. Maybe it's legit (patient responsibility), maybe it's not. This is where you catch short payments.

7. Patient Responsibility (Copay/Deductible/Coinsurance) What your patient supposedly owes. But here's the kicker: if you're out-of-network, they'll inflate this number and act like their hands are tied. "Contractual obligations," they'll say, as if that explains why your reimbursement is insulting.

Red Flags That Scream "You're Getting Screwed"

Watch for these insurance company favorites:

"The EOB is not a bill" - They love this disclaimer. It means "this isn't final, we might change our mind, and you have zero recourse." Spoiler: the EOB may not be accurate. Like, at all. Errors are so common it's almost impressive. If something looks off, it probably is—file for resubmission, corrected claims, or appeals immediately.

Mystery Fees - Some EOBs have random "administrative fees" or "network access fees" deducted by middlemen like American Specialty Health or Zelis. These companies skim money off your reimbursement, and insurance acts like they have nothing to do with it. Call them out on it.

"Allowed amounts" that keep dropping - If your allowed amounts suddenly decrease with no explanation, insurance is hoping you won't notice. You just did. Time to fight back.

How to Actually Win This Game

Stop skimming. Yes, EOBs are designed to bore you into submission. Read every line anyway. That's how you catch the "$200 underpayment" that adds up to thousands over a year.

Keep every EOB. When insurance denies your appeal claiming "we never received that," you'll have receipts. Documentation is your weapon.

Ask questions aggressively. If something doesn't make sense, make them explain it. Force them to justify their logic. Half the time, they can't—and suddenly your "denied" claim gets approved.

Know what you billed vs. what you got paid. Run reports monthly. If there's a pattern of underpayments on specific codes, insurance is testing whether you're paying attention.

The Bottom Line

Insurance companies are counting on you to accept whatever they pay and move on. They're betting you won't notice the short payments, won't question the denials, and won't have time to fight back.

Prove them wrong.

Tired of Fighting Insurance Companies Alone?

Look, we get it. You didn't go into healthcare to become a billing expert and insurance company watchdog. You've got patients to see and a practice to run.

That's exactly why Bushido Billing exists. We catch the underpayments, fight the BS denials, and make sure you get every dollar you've earned—so you can focus on what actually matters.

Ready to stop leaving money on the table? Let's talk.

SCHEDULE YOUR FREE DISCOVERY SESSION TODAY.