You’ve been to the doctor and paid your copay. How are you going to know when your claim is filed and finalized? Simple, you’ll get your Explanation of Benefits (EOB). Your EOB will break down the service you received at the doctor’s office, the cost and what you might have to pay.
What is a health insurance Explanation of Benefits (EOB)?
An Explanation of Benefits (EOB) Statement is a notification provided to members when a health care benefits claim is processed by Blue Cross and Blue Shield of New Mexico(BCBSNM). The EOB displays the expenses submitted by the provider and shows how the claim was processed. In most cases, an EOB will be mailed to you after a claim has been finalized. If you signed up for paperless statements, you will get an email notice when your EOB is ready for viewing through your Blue Access for MembersSM (BAM) account.
Your EOB statement is an important record of claims for medical services and benefit coverage. The first thing you should do is carefully check your EOB. You want to be sure that the services you received match the services you were billed for. If something looks wrong, call us using the number on the back of your Member ID card or call your doctor to ask about it. Then, keep your EOBs for future reference -- just in case questions come up later about your claim or your bill. (Bonus if you’ve registered for BAM! We store your EOBs there for 18 months.)
The EOB may include additional information:
The EOB has three main sections:
Below is a sample EOB that labels all the sections. Keep in mind, every plan is different and the charges on your EOB are according to your plan’s coverage and the services you received.
Key areas of your EOB:
We know it gets a little tricky, so if you have questions about this explanation of your Explanation of Benefits, let us know in the comments!
If you want to learn more about EOBs, go to BAM or check out any of these great Health Care Coverage 1-on-1 videos!
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