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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 statements, you'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.
A. Your member ID and group numbersB. How to access your claims onlineC. Helpful contacts and glossary
Top:D. Patient informationE. Provider informationF. Policy information
Details:G. Amount billed by the providerH. Discounts and reductions in compliance with your planI. 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 providerK. Deductible amountL. Copay amountM. Coinsurance amountN. Amount not coveredO. The amount you’re responsible for. This column provides details about the amount you may owe shown in the claim summary (O2)O2. Claim summaryJ2. Total covered benefits approved is the amount that was paid to the providerP. Numbered notes provide additional detailsQ. Health care plan maximums
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.
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, 2022
Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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