Jan 21, 2019

Understanding your EOB

An EOB (Explanation of benefits) is a statement sent by your Insurance Carrier explaining what medical treatment(s) and/or services that were paid for on your behalf. 

There is a lot of information packed into your EOB, so it can be a bit confusing or overwhelming on what you are looking at.

Things to Know & Remember

  • The EOB is NOT a bill. An EOB explains how your benefits were applied to a certain claim.
  • Each time you receive an EOB, examine it closely and compare it to the receipt/statement received from the provider.
  • The EOB will contain/provide the following:
    • Date of service (Date when you actually had medical treatment/service)
    • Amount billed
    • Amount covered
    • Amount paid by carrier
    • Any balance you as the member are responsible for. (balance due to provider)
    • How much has been credited toward any deductible (any required)

We recommend keeping all EOB’s for at least 2 years for record purposes and reference.

EOB Terms to Knows

  • Procedure – The type of services or products you received from your provider.
  • Provider – Where service or products were received
  • Dates of Service – The date(s) you received service.
  • Amount Billed – The full amount billed by your provider to your health plan.
  • Reference Number Explanation – This is a BCBS network discount. The member is not responsible for this amount. For inquiries, call our office between 8am & 6pm EST at: 800‑578‑3272 *
  • Paid To – This column shows where a payment has been sent. (Doctor Office, Hospital etc.)
  • Co-pay – A set amount you pay for certain covered services such as office visits or prescriptions. Typically, these are paid at the time of service.
  • Deductible – Your deductible is the amount you need to pay each year for covered services before your plan starts paying benefits.
  • Coinsurance – A percentage of covered expenses that you pay after you meet your deductible.
  • Ineligible – A portion or amount of the amount billed that was not covered or eligible for payment under your plan.
  • Total Responsibility (What you Owe) – This section the of the bill shows what is your responsibility to pay. This amount might include your co-pay, deductible, coinsurance, any amount over the maximum reimbursable charge, or products/services not covered by your plan.

*Please refer to your plan document for your rights regarding the appeal process on claim disputes.