Who is the primary recipient of an Explanation of Benefits (EOB)?

• A. The insurance company.
• B. The hospital administrator.
• C. The patient.
• D. The employer.

Answer: (C)

An Explanation of Benefits is the payer’s detailed statement about a processed claim, showing what services were billed, what was allowed, what the plan paid, and what the patient owes. The primary recipient is the patient because it’s the information the insured needs to understand their financial responsibility, review for accuracy, and decide whether to pay, appeal, or file a dispute. While the insurer generates and sends the EOB, it’s intended for the patient (often sent to the subscriber as well). Hospitals or employers may receive other payment communications, but the EOB itself is directed to the patient to explain benefits and any remaining balance.