Making sense of your EOB

What does it all mean? We'll help you take a closer look at your Explanation of Benefits, or EOB. 

Every time you use your health insurance benefits, you’ll receive an explanation of benefits, or EOB. It shows what the provider charged, what the insurance company paid and what you owe the provider.

The most important thing to know is that the EOB is not a bill. It’s communication that lets you know BCBSND received a claim and we’re processing it on your behalf.

Breaking it down

EOBs can look a little intimidating, but the fact is, they’re required by law, so they resemble a legal document. Once you understand the most important parts, they’re easier to understand.

1. Explanation of Health Care Benefits

The top of the EOB form gives the incidentals, like dates, names, claim number, insurance plan identification and provider information.

2. Provider Responsibility Amount

The grid section breaks down payment information. You’ll see how much the provider charged, followed by any adjustments made per their agreement with BCBSND, resulting in “Allowed Amount” column.

3. Patient Non-Covered Amount

Depending upon your plan, some services aren’t covered. Those charges would be indicated here.

4. Co-Insurance Amount

Deductible, copayment and coinsurance are cost sharing amounts that are your responsibility. Next is the amount BCBSND paid the provider on your behalf.

5. Amount You Owe

The most important part of the EOB is the amount you owe. When you get a bill from the provider, the amount charged should match this number.

6. Patient Benefit Summary

In the summary section, you’ll see any additional notes about how your claim was processed, plus a running tally of your cost sharing amounts for the year.

 

Tired of all the paper?

Unless you request otherwise, your EOB will arrive in your USPS mailbox. If you’d rather view them online, you can sign up for paperless EOBs when you log in to or create an online Member Services account. That’s also the place you can manage most everything related to your BCBSND insurance coverage.