After you go to the doctor, you can expect to receive something in the mail from your insurance provider called an Explanation of Benefits (EOB), sometimes called a “claims statement.” If you signed up for paperless statements, you’ll receive an email saying the EOB is now available for viewing through your online account. When the EOB arrives, you can feel assured that your insurance claim has been processed by both the health care provider and your insurance company.
It’s important to note that the EOB or claims statement is not a bill. Rather, it is a tool that outlines the services you’ve received, the costs for those services, any discounts or payments already made for those services, and the amount you will pay when billed. By carefully reading the EOB, you can ensure that it’s accurate. If you find an error, call the customer service number on the back of your member card.
Here, we’ll breakdown the EOB and explain what each part means.
- The first section of the EOB includes basic information about the patient and the patient’s plan. There, you’ll see details as the member’s name, address, member ID number and group name and number.
- The second section is a summary that outlines the charges from you latest medical service, what your plan covered and what you’re responsible for covering.
- The claim detail section outlines how much you owe, including the amount billed, any payments or reductions. Here, you’ll find information such as the service provider’s name, date of service, type of service, charges submitted by the health care provider, charges allowed by the insurance plan, payments made and the amount remaining that the policy holder may owe. If additional information is needed, it is usually provided here.
Here’s an example of how a patient should read their EOB:
Claudia recently had an appointment with a doctor and a few tests were performed. Soon after, she receives an EOB detailing the medical services she received. She reads it closely, ensuring that all of her personal information is correct. She pays attention to the amount that was billed for the service ($450); the discounts received through her insurance plan ($360); and the amount she may owe ($90).
After reading the EOB, Claudia concludes that the information is accurate. She files it away, and waits to receive a bill for the service before taking any action.
Did you recently receive health care services? Now that you’re familiar with the different components of the EOB, log on to your Blue Cross Blue Shield of Alabama account and see if you’ve received one.
