How to read your Explanation of Benefits

May 30, 2013 Denise Pinkney

Explanation of Benefits Guides

Each time a claim is filed from your doctor, we send you an Explanation of Benefits (EOB) form which provides important information about how your claim was processed.

Do you get EOBs in the Mail?

Explanation of Benefits front page

1. This is Not a Bill: Please do not send payment for this service to BCBSND. Please keep this form for your records.

2. Date: Date the EOB is printed. Benefit Plan Number: The member's BCBSND benefit plan number. Page Number: Identifies the number of pages for this EOB.

3. Member Services Phone Numbers: The numbers you should call with questions on this EOB.\

4. Patient/Claim Number: The name of the patient who received the service and the claim number designated for the purpose of identification.

5. Paid To: The name of the individual or institution that was paid for the service.

6. Total Charge: The total charge associated with the claim. Covered Amount: The portion of the claim that has been discounted or paid by this plan. Previously Processed: Any amount previously processed by this plan, Medicare or another insurance company.

7. Your Responsibility To The Provider: The total amount that you are responsible to pay to your provider.

8. Year To Date Cost Sharing Status: The total deductible, coinsurance, and/or copayment that you have accumulated to date. These totals may reflect claims in process for which you have not yet received an EOB.\

9. Important Message: This space has been reserved for general messages that may apply to you.

 

Back of EOB

Explanation of Benefits back page

10. Date: Date the EOB was printed. Name: Member's name. Benefit Plan Number: The member's BCBSND benefit plan number. Group Number: The member's health insurance plan group number.

11. Date of Service: The date the service was performed.

12. Charges Submitted: The charge billed by your provider for each service.

13. BCBS Discount: The portion of your charge that may have been reduced by BCBS for services provided by a Participating Provider.

14. Blue Cross Blue Shield: The amount the member's coverage paid toward each service.

15. Previously Processed: Any amount previously processed by this plan, Medicare or another insurance company.

16. Noncovered Charges: The charges that are noncovered according to the terms set forth in your benefit plan.

17. Deductible: Specified dollar amount for certain covered services received during the benefit period that is your responsibility to the provider.

18. Coinsurance: Percentage of the allowed charge for certain covered services that is your responsibility to the provider.

19. Copayment: Specified dollar amount payable for certain covered services that is your responsibility to the provider.

20. Your Responsibility To The Provider: The total amount that you are responsible to pay to your provider.

21. Explanation Of Notes: Explanations or descriptions corresponding to the amount(s) noted in the breakdown of charges and benefits (sections 13, 15 thru 19 shown above).

 

Do you get your EOBs electronically?

Electronic Explanation of Benefits document

1. Claim Number: The claim number designated for the purpose of identification. Benefit Plan Number: The member's BCBSND benefit plan number.

2. Name: Member's name. Group Number: The member's health insurance plan group number.

3. Request Date: The date the EOB was downloaded from the member online services web page. Original Processed Date: The original date the EOB was processed.

4. Patient/Claim Number: The name of the patient who recieved the service and the claim number designated for the purpose of identification.

5. Paid To: The name of the individual or institution that was paid for the service.

6. Total Charge: The total charge associated with the claim. Total Paid: The portion of the claim that has been paid by this plan. Total Discount: The portion of your charge that may have been reduced by BCBS for services provided by a Participating Provider.

7. Total Not Paid: The total amount that you are responsible to pay to your provider.

8. Provider/Description: The name of the individual or institution that performed the service and the type of service that was performed.

9. Date of Service: The date the service was performed.

10. Charge: The charge billed by your provider for each service. Paid: The amount the member's coverage paid toward each service. BCBS Discount: The portion of your charge that may have been reduced by BCBS for services provided by a Participating Provider.

11. Not Paid: The amount that you are responsible to pay to your provider for this individual item.

12. Explanation Of Notes: Explanations or descriptions corresponding to the amount(s) noted in the breakdown of charges and benefit shown above.

 

Electronic versions of your EOBs can be downloaded in PDF format by logging in to your online member account.

 

Additional Resources

 

Get EOB notifications by email

Sign up for electronic EOBs

Cut down on paper clutter

Save all your EOBs in one place