What does an Explanation of Benefits (EOB) describe?

An Explanation of Benefits (EOB) is a document provided by a health insurer to inform the insured about what medical services have been processed in relation to a claim. It details the services rendered to the patient, which is essential for understanding the scope of medical care received. Additionally, it specifies the payments that the insurance plan has covered, outlining how much has been paid to the healthcare provider and what the provider’s charge was.

The EOB includes information about benefit limits or denials, which makes it clear to the insured if there are any limitations on coverage for specific services or any claims that were denied for various reasons. This comprehensive breakdown is crucial for ensuring that patients are aware of their financial responsibilities and the status of their claims.

Other options describe aspects that are not covered by an EOB. For instance, while time of service payments and out-of-pocket expenses may be relevant in the billing process, they do not encapsulate the full scope of what an EOB entails. Similarly, unresolved billing disputes may relate to claims and payments but are not detailed in an EOB. Thus, option C accurately captures the essence of what an EOB provides to patients regarding their healthcare claims.