Reading Your EOB: A Plain-English Guide for Therapists

An Explanation of Benefits (EOB) — or its electronic equivalent, an ERA — arrives after every processed claim. It's dense, full of codes and abbreviations, and easy to ignore. But it's also the single best source of information about how a payer is actually treating your claims.

The key numbers

Every EOB shows the billed amount (what you charged), the allowed amount (what the payer's contract permits for that service), the paid amount (what was actually sent to you), and the patient responsibility (copay, coinsurance, or deductible the patient owes).

Adjustment and denial codes

If the paid amount is less than expected, the EOB will include a code explaining why — a contractual adjustment (normal, expected), an applied deductible, or a denial code indicating a problem with the claim itself (eligibility, authorization, coding, etc.).

What to track over time

A single EOB tells you about one claim. Looking at EOBs across a month tells you about patterns — are denials clustering around one payer? One CPT code? One type of error? That pattern is exactly what monthly reporting should surface, so you can fix the root cause instead of re-fighting the same denial every month.