Explanation of Benefits documents are unreadable even to healthcare professionals

After every medical visit, insurers mail an Explanation of Benefits (EOB) that uses proprietary billing codes, nested adjustment columns, and ambiguous "you may owe" language that even physicians and billing specialists cannot parse reliably. Patients cannot tell from the EOB whether they owe money, how much, or whether the claim was processed correctly, so they either ignore legitimate bills (which go to collections) or pay inflated amounts without questioning. A 2023 JAMA study found that 80% of medical bills contain errors, but patients lack the literacy to catch them. This persists because EOB formatting is not standardized by CMS for commercial plans, and insurers have no incentive to make them clearer since confused patients are less likely to appeal underpayments or catch billing mistakes.