An Explanation of Your Explanation of Benefits

An Explanation of Your Explanation of Benefits

An Explanation of Your Explanation of Benefits

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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 services you received, the cost of the services and what you might have to pay. Your EOB is not a bill.

What Is an EOB?

An EOB is a notice you get when a health care benefits claim is processed by your health plan. The EOB shows the expenses submitted by the provider and how the claim was processed.

If you get paper EOBs, an EOB will be mailed to you after a claim has been finalized. If you are signed up for paperless statementsyou'll get an email when your EOB is ready to view in your Blue Access for MembersSM (BAMSM) account.

Below is a sample EOB that explains all of the sections. Keep in mind that every plan is different. The charges on your EOB are according to your plan's coverage and the services you received.

Basics of Your EOB Page One

NM EOB page one

A. Your member ID and group numbers
B. How to access your claims online
C. Helpful contacts and glossary

Basics of Your EOB Page Two

NM EOB page two

D. Patient information
E. Provider information
F. Policy information

G. Amount billed by the provider
H. Discounts and reductions in compliance with your plan
I. Amount covered is the amount billed (G) minus the discounts and reductions (H)
J. Health plan responsibility is the portion your health plan pays to the provider
K. Deductible amount
L. Copay amount
M. Coinsurance amount
N. Amount not covered
O. The amount you’re responsible for. This column provides details about the amount you may owe shown in the claim summary (O2)
O2. Claim summary
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 EOBs

Your EOB is an important record of claims for services paid from your benefits. You need to 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 at the number on your member ID card. Or call your provider's office to ask about it.

Keep your EOBs in case questions come up later about your claim or your bill. If you’ve registered for BAM, we store your EOBs there for 18 months.

If you have questions about this explanation of your Explanation of Benefits, sign in and let us know in the comments below.

Learn more about your EOB in this video. You can get more information in your BAM account. And checkout these Health Care Coverage 1-on-1 videos to learn more about EOBs and other coverage information and insurance terms.

Originally published 8/18/2015; Revised 2019, 2021