The Explanation of Benefits (EOB) has long been a fixture in post-claim communication for health insurers. Sent after every adjudicated claim, it’s meant to help members understand how their benefits were applied. But in practice, the EOB has become one of the most misunderstood and frequently overlooked communications in healthcare.
Instead of providing clarity, EOBs often confuse. They contain codes and disclaimers, complex line items, and layouts that fail to answer basic questions: What was billed? What did the plan cover? What does the member owe, if anything? For many recipients, the EOB feels like a dead-end document -dense, delayed, and disconnected from the rest of their experience.
This confusion carries consequences. When members don’t understand their EOBs, they call. They delay payments. They lose trust. And while the cost of sending an EOB may seem marginal, the operational impact of misunderstanding- measured in support time, follow-up requests, and dissatisfaction - is not.
So why haven’t EOBs evolved?
An EOB is not a bill, but it’s often interpreted as one. It’s a formal summary that outlines what services were billed by a provider, what portion was covered by the member’s health plan, and what amount, if any, is the member’s responsibility. It also includes how much the plan paid and explanations for any amounts not covered.
Though required, the EOB is rarely treated as a strategic communication. That’s a missed opportunity.
EOBs are often formatted in a way that prioritizes compliance over comprehension. The information is there, but it’s buried in codes, technical language, or inconsistent design. Many EOBs lack clear headings or visual hierarchies that allow members to quickly grasp the essentials.
Moreover, the terminology used across different insurers varies widely. A member covered by two plans may receive two very different-looking EOBs for the same procedure.
Every confused member response has a cost. A phone call to clarify what the EOB means. A delayed payment because the member thinks it’s a bill. A duplicate claim or grievance filed due to misunderstanding.
These interactions are measurable and avoidable. Poor communication after a claim doesn’t just undermine satisfaction scores. It increases administrative workload, drives up support costs, and slows down the post-claim cycle.
EOBs must be reframed as communications, not just artifacts. That begins by rethinking how they’re created and delivered:
The EOB must be readable, relevant, and reliable. If it doesn’t immediately answer the member’s most pressing questions, it isn’t doing its job.
Members expect digital access to their information. Paper-only delivery is increasingly perceived as outdated or worse, as an inconvenience. Delays introduced by print-and-mail systems widen the gap between the member’s care experience and their understanding of its cost.
Email notifications, secure portal access, and mobile alerts offer members faster insight and greater control. They also reduce the likelihood of misplaced documents, unopened mail, or late follow-up.
Digital delivery also opens the door to accessibility improvements, visual formatting, and usage analytics that simply aren’t possible in static print formats.
Trust is built through consistency. When members know what to expect and can find the answers they need quickly, they are more likely to trust the process, and by extension, the insurer behind it.
That starts with structure: clear headings, well-labeled totals, side-by-side breakdowns of provider charges versus plan payments. It continues with tone: replacing code-laden footnotes with explanatory text that acknowledges the member’s perspective.
And it ends with design: clean, branded, mobile-responsive layouts that reflect the quality of the healthcare organization providing them.
The EOB is not just a compliance requirement, it’s a chance to reinforce clarity, transparency, and trust after every claim. As insurers invest in digital transformation, post-claim communication should be part of that roadmap.
At DataOceans, we support health insurers in taking this next step. Our solutions unify member data, support delivery across channels, and produce clear, personalized EOBs that help members understand their benefits without needing to ask. Because when members understand their EOBs, everyone benefits.
Ready to improve how your EOBs support clarity, compliance, and member satisfaction? Let’s talk about how to modernize your post-claim communications with confidence.