Then under quick links, click the document center link. Any provider writeoffs that were applied for using a participating provider. Your eob also shows how much has been credited toward your calendar year deductible. A tricare explanation of benefits eob is not a bill. Definition of terms on your explanation of benefits eob. Total charge is the dollar amount charged by the provider of service. Explanation of benefits please retain for your records. The date that services were provided to the patient. An explanation of benefits eob is a form or document provided to you by your insurance company after you had a healthcare service for which a claim was submitted to your insurance plan.
Guide to your explanation of benefits see how your benefits are working for you with this easytounderstand document that shows you the costs associated with the medical care youve received. An eob is not a bill and helps to make sure that only you and your family are using your coverage. This is an overview of the total charges for your visit and how much you and your health plan will have to pay. When a claim is filed under your cigna benefits plan, you get an explanation of benefits eob. This will help plan members and providers understand how. How to read your explanation of benefits eob reading your explanation of benefits eob. Understanding an explanation of benefits eob after youve seen a provider for care, you will likely receive a document from medica called an explanation of benefits eob. An explanation of benefits eob is a notification provided to members when a health care benefits claim is processed by blue cross and blue shield of new mexico bcbsnm.
Depending on the services you receive and your plan type, your eob may have data. Your appeal rights are explained in your plan documents which can be found on your secure member account at. Your eob gives you information about how an insurance claim from a health provider such as a doctor or hospital was paid on your behalf. Ineligible amounts are further explained in reason code description see.
The eob is a record of the services you or another covered family member received on a certain date. Its available at with this useful tool, you can get your daily list of eob statements online in pdf. The following family members are eligible for medical, dental and vision coverage. An explanation of benefits eob is a notification provided to members when a health care benefits claim is processed by blue cross and blue shield of illinois bcbsil. Sample explanation of benefits office of group benefits this is a sample of our new explanation of benefits form, along with descriptions of various sections. Explanation of benefits eob the following sample of an explanation of benefits eob is provided for informational purposes. This will ensure that the 45day requirement is met. Aarp medicare complete sample explanation of benefits. A sample eob is shown below with the most common sections described. To view your summary explanation of benefits, begin by clicking on customer resources.
Aetnas claim explanation of benefits eob tool get your eobs faster than through the mail 23. Below is a description of your explanation of benefits. Youll get one after every visit to a care provider. Aarp health insurance plans pdf download medicare replacement pdf download medicare benefits pdf download medicare part b pdf download sample eob with explanations medicare. Understanding your explanation of benefits pdf health net. The amount your provider has billed for health care services you received. Explanation of benefits statement below is a sample explanation of benefits eob statement. An explanation by line number of the reasons certain charges were excluded. This is the information you will receive after your benefits claim has been processed. You may get multiple eobs for some services, like surgeries. Ineligible is any dollar amount not covered by the plan. View a sample explanation of benefits pdf with definitions. This is a sample eob and does not reflect actual charges or services rendered, nor does it reflect actual charges or services received by an actual aetna member.
Understanding your your health insurance provider explanation. This document lists all your medical costs that have been applied toward your deductible and outofpocket maximum during the calendar year. Reading your explanation of benefits your explanation of benefits eob is a simple recap of how your health plan paid for medical care or services you received. In order to understand this example, match the field number on the eob to the corresponding. Understanding your explanation of benefits customer service date.
Mar 24, 2015 what is an explanation of benefits letter. Your eob gives you information about how an insurance claim from a health provider such. An appeal must be made within 180 days of receiving an explanation of benefits eob showing a claims denial. Reading your explanation of benefits eob the ren clinic. Some be in the know bonus actions require an explanation of benefits be submitted with your proof of bonus actions form to receive the points for the activity. Total billed dollar amount the provider physician, hospital, etc. Once your health insurance pays its part, the hospital or doctors office sends you a bill for the portion you owe. This is a replica of the explanation of benefits eob you receive from geha after a trip to your health care provider. Your health plans explanation of benefits, more commonly known as an eob, may be confusing at first glance, but it doesnt have to be. If your eob shows that you are responsible for some of the cost, your provider will bill you separately.
It may not reflect payments already made by you or another. Instead, it explains how your benefits have been applied. Choose to opt out of receiving eobs by mail to save time and resources. Understanding your explanation of benefits blue cross blue. The information on your explanation of benefits reflects. Do not attach a copy of the explanation of medicare benefits aarp health insurance plans pdf download medicare replacement pdf download medicare benefits pdf download medicare part b pdf.
Header explanation of benefits notes payment to accumulators claim identification continued. The following example explains how to read the meritain health eob. The numbers correspond with the numbers on the sample copy of the eob see the last page for an example of an eob. Understanding your explanation of benefits eob trsactivecare. How to view your eob and summary eob view your eob and summary eob your explanation of benefits details medical claims 5 that have processed in the last 30 days. Dates of service the actual date and or timeframe when you received. Medicaid sample explanation of benefits eob this is not. Eob statement details this identifies who this eob statement is for. Explanation of benefits below is a description of your explanation of benefits eob.
Understanding your explanation of benefits example summary. Nov 1, 2015 a sample of the hfs 2360 pdf may be found on the departments web site. These faqs and the samples following explain what an explanation of benefits is, when you may need one, and how to get one from your insurance provider. A footnoted explanation indicates the reason member name and address tollfree customer service number note. The patient is able to see what the provider is billing them for. When a claim is filed under your benefit plan, youll receive an eob showing what was billed, any blue cross discounts, what we paid and what you pay. Insurance companies have call and support centers to help plan members. In order to understand this example, match the field number on the eob to the corresponding number shown in the following narrative. If you suspect any form of insurance benefit fraud, please call our fraud hotline at 18008767858. An eob is not a bill and helps to make sure that only you and your family are using your.
Summary of benefits and coverage instruction guide for group apr 1, 2017 benefits otherwise not covered by the major medical coverage. Explanation of benefits statement eob eob field explanations. Keep eob statements with your health insurance records for reference. How to read the delta dental of iowa explanation of. The information below is a summary of your healthcare claims for the period referenced above. Refer to the following for descriptions of the numbered items on the sample eob on the nextback page. Explanation of benefits the number associated with the claim. See how your benefits are working for you with this easytounderstand document that shows you the costs associated. Apr 26, 2016 sample explanation of benefits office of group benefits this is a sample of our new explanation of benefits form, along with descriptions of various sections. Explanation of benefits definition understanding eobs.
Below is a description of your explanation of benefits eob. The eob is generated when your provider submits a claim for the services you received. The total amount applied to the deductible yeartodate for this claimant and for the family new explanation of benefits form this is a sample of our new explanation of benefits form, along with descriptions of various sections. The remaining amount after your discount and what your plan paid in benefits. Explanation of benefits some be in the know bonus actions require an explanation of benefits be submitted with your proof of bonus actions form to receive the points for the activity. Your benefits booklet includes information on how to file an appeal. Date of service the date the procedure was completed. Ex code explanation of code definitions explanation of code this alpha andor numeric code provides a detailed description of the payment determination.
Do not attach a copy of the explanation of medicare benefits aarp health insurance plans pdf download medicare replacement pdf download medicare benefits pdf download medicare part b pdf download. You can write to customer service at this location. Explanation of service codes provides additional information see box 21. Depending on the services you receive and your plan type, your eob may have data in the same or diferent areas. The eob shows what your provider charged, what portion geha will cover and what portion, if any, you are responsible for paying. These faqs and the samples following explain what an. The action you take if you dont agree with a decision made about your benefit.
United concordia dental explanation of benefits keep for your tax records 0 id number. Refer to this number if you need to contact us with questions. Reading your explanation of benefits eob after you visit your provider, you may receive an explanations of benefits eob from your insurer. The doctor, health care professional or facility that provided care and has filed the claim. There are a few primary reasons why the explanation of benefits is important to the patient. Patient responsibility2 the total amount the patient is responsible for.
Sample 200000001 explanation of benefits this summary information is for claims processed for all members covered under the subscriber id indicated above. A quick guide to your explanation of benefits statement. The insurance company sends you eobs to help make clear. Your explanation of benefits, or eob, statement shows you the costs associated with the medical care youve received. March 24, 2015 november 4, 2015 by ryan mentock this is the first article in a series about the explanation of benefits summaries that the patient receives after their provider files a medical claim. An eob is a statement from your health insurance plan describing what costs it will cover for medical care or products youve received. Mammograms save lives benefits for innetwork services.