Bill vs EOB
Why Does My EOB Show a Different Amount Than Expected?
An EOB showing a different amount than expected is usually due to how your plan calculates allowed amounts, applies deductibles, or processes coinsurance.
Updated August 16, 2026 · 6 min read
Quick answer
If your EOB shows a different amount than expected, the difference is usually caused by your plan allowed amount, deductible status, coinsurance percentage, or the difference between in-network and out-of-network rates.
The Allowed Amount Is Not the Billed Amount
The allowed amount on your EOB is the maximum your plan recognizes for a service. It is determined by negotiated rates with in-network providers or by a percentage of Medicare rates for out-of-network providers.
Deductible Status Matters
If you have not yet met your annual deductible, the allowed amount goes toward your deductible first. Once your deductible is met, your plan starts paying its share.
Coinsurance Applies After the Deductible
After your deductible is met, you typically owe a percentage of the allowed amount. A 20% coinsurance on a $500 allowed amount means you owe $100 and insurance pays $400.
Frequently asked questions
Why is the allowed amount lower than what the provider charged?
Your plan negotiates rates with in-network providers that are lower than their standard charges. The allowed amount reflects this negotiated rate.
Can I appeal if I think the EOB is wrong?
Yes. Contact your insurer and request a review of the claim. If processed incorrectly, your insurer must reprocess it.
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