What does the Explanation of Benefits (EOB) include?

The Explanation of Benefits (EOB) is a document provided by an insurance company to policyholders after a claim has been processed. It serves several important functions, primarily focusing on the financial aspects of medical services received. The correct choice highlights that the EOB includes a summary of insurance payments along with the patient's financial responsibilities, such as copayments, deductibles, and any amounts that the patient may still owe the provider after the insurance has made its payment.

When a healthcare provider submits a claim to an insurance company for services rendered, the insurance evaluates that claim and determines what portion it will cover according to the policy terms. The EOB provides a clear breakdown of these payments, outlining exactly how much was paid by the insurance, what services were covered, and what costs are the responsibility of the patient. This information is crucial for patients to understand their financial liability and to ensure they are billed correctly by the provider.

Other options are not accurate representations of the purpose of an EOB. For instance, the document does not review appointment scheduling or serve as an agreement between the provider and the patient, nor does it act as a checklist for medical procedures. The primary intent of the EOB is to facilitate clear communication about the financial aspects of healthcare services,