The Pulse, March 2022
What is an Explanation of Benefits (EOB)?
You went to the doctor and paid your copay. How will you know when your claim is filed and finalized? Simple — you'll get your Explanation of Benefits (EOB) from Blue Cross and Blue Shield of Texas (BCBSTX).
The EOB is not a Bill
The EOB tells you the services you received, the cost of the services, and what you might have to pay. The EOB shows the expenses submitted by the provider and how we processed the claim.
If you get paper EOBs, we will mail an EOB to you after we finalize a claim. If you get paperless statements, you'll get an email when your EOB is ready to view in your Blue Access for Members℠ (BAM℠)account.
Information at Your Fingertips
There’s a lot to understand with your EOBs, and the information may seem overwhelming. Let us unpack it for you.
Below is a sample EOB that explains all the sections. Keep in mind that every plan is different. The charges on your EOB are based on your plan coverage and the services you received.
Basics of Your EOB Page One
Figure 1. A Sample of Page 1 of an EOB A.
On the top left, it displays your member ID and group numbers
B.
On the top right, it provides information on
- How to access your claims online — Sign up to get your EOBs online on
Blue Access for Members℠ or text GOBCBSTX to 33633 to download the mobile app.*
- Customer Support Contact Info
C.
The main content provides helpful contacts and glossary.
Navigating Page Two
There is even more information included on page two of your EOB, and we’ll break it down for you.
On the top left, it displays:
D. Patient information
E. Provider information
On the top right, it displays:
Figure 2. A Sample of Page 2 of an EOB
In the main area, it displays these details:
G. Amount billed by the provider
H. Discounts and reductions in compliance with your plan
I. The amount covered is the amount billed (G) minus the discounts and reductions (H)
J. Health plan responsibility is the portion your plan pays to the provider
K. Deductible amount
L. Copay amount
M. Coinsurance amount
N. Amount not covered
O. The amount you may owe. This column provides details about the amount you may owe shown in the claim summary (O2)
At the bottom, it displays:
J2. Total covered benefits approved is the amount that was paid to the provider
P. Numbered notes provide additional details
Q. Health care plan maximums
Always Check Your EOB
Your EOB is an essential record of claims for services paid from your benefits.You need to carefully review it to be sure that the services you received match your billed services.
If something looks wrong, call a Personal Health Guide (PHG) at 1-866-355-5999. Or ask your provider's office. Keep in mind that PHGs can also speak to your provider office.
Keep your EOBs if questions come up later about your claim or your bill. We store your EOBs in BAM for 18 months.
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
Republished with permission of BCBSTX
