How to Read Your Explanation of Benefits (EOB) — A Guide for Families
Last updated: July 27, 2026
For: Parents & caregivers of children receiving ABA therapy · From: Alpaca Health · Draft flyer for review
A friendly, one-page walkthrough of the paperwork your insurance sends after each visit — so you know what it means and whether you owe anything.
First things first: an EOB is not a bill 🚫💵
After your child has a session, your insurance company sends an Explanation of Benefits (EOB). It shows how your insurance processed the claim. It often says something like “This is not a bill” at the top — and that's true. You don't pay from an EOB. If you owe anything, a separate bill will come later.
What the EOB is telling you
An EOB answers three questions:
What service was billed? (the date and type of visit)
What did insurance pay?
What, if anything, is your family's share?
The words on the page, explained simply
What it says | What it means for you |
|---|---|
Amount billed / charged | The provider's starting price. This is not what you owe. |
Allowed amount | The rate your insurance and the provider have agreed on. |
Paid by plan / insurance paid | What your insurance covered. |
Deductible | The part applied toward the amount you pay before insurance starts covering. |
Copay / coinsurance | Your flat fee or percentage share for the visit. |
Not covered | Anything the plan didn't pay (sometimes an adjustment the provider writes off — not always your cost). |
Patient responsibility / “You may owe” | 👈 This is the line that matters most. It's your family's estimated share. If it says $0, you owe nothing. |
How to read it in 30 seconds
Find the date of service — make sure it's a visit your child actually had.
Jump to “Patient responsibility” (sometimes called “You owe” or “your share”).
If it's $0, you're all set. If it shows an amount, wait for the actual bill before paying — and reach out to us if it looks surprising.
Situations that confuse a lot of families
“The billed amount is huge — do I owe all of that?”
No. The big number is the starting price. What you actually owe is only the patient responsibility line, which is usually much smaller (and often $0).
“We have two insurance plans — the EOB shows a balance.”
When a child has two plans, the first (primary) processes the claim, then the second (secondary) picks up the rest. If the two insurers haven't been told about each other yet (this is called Coordination of Benefits, or COB), you might temporarily see a balance. A quick call to each insurer to confirm your child has both plans usually fixes it — and we're happy to walk you through it.
“We have Medicaid as a second plan.”
In most cases, when Medicaid is the secondary plan, your out-of-pocket cost is $0. If an EOB seems to show otherwise, let us know — it's often just a COB step that needs updating.
“The EOB says denied.”
A denial doesn't always mean you owe money — it often means a claim needs to be corrected or resubmitted, which is our job to handle. Please don't worry or pay anything; reach out and we'll look into it.
“We got a new insurance card / our plan changed.”
Please send the updated info to your provider or to us right away so claims stay accurate.
When in doubt, ask us 💬
You never have to decode this alone. Contact Alpaca Health at support@alpacahealth.io and we'll explain exactly what your EOB means and whether you owe anything.
A good rule of thumb: Don't pay from an EOB. Wait for a bill, and check with us first if anything looks off.
Want to know what therapy will cost? 💡
We're happy to give you an estimate of your weekly or monthly cost based on your plan and your child's recommended hours. A couple of honest notes:
It's an estimate, not a fixed price — the real amount can differ once claims process.
Insurance rates can change during the year, so an estimate we give today may shift a little over time.
Just ask us and we'll walk through it with you.
If a number looks off, it may just need re-checking 🔎
Sometimes a benefits summary shows a $0 copay, a blank out-of-pocket max, or "N/A" where you'd expect a number. That often just means the insurance info needs to be pulled again (this is common when a child has more than one plan) — it's not a final answer. If something looks surprising, let us know and we'll re-verify it for you.