What is an explanation of benefits?

Why you get an explanation of benefits, and what you should do with it

After you get care from a doctor or hospital, you will receive an explanation of benefits (EOB) from Blue Cross of Idaho. An EOB is not a bill – it’s an overview of the care you received, the cost of that care and what we paid for per your plan benefits. You may get a bill from your provider.

11 important parts of an EOB

Even though an EOB isn’t a bill, it’s a good idea to review it and keep it for your records. Here are 11 of the most important parts of the EOB statement:

1. THIS IS NOT A BILL
   When you get an EOB, keep in mind that it’s not a bill, but an explanation.
2. PATIENT
   The name of the person who received this service. This could be you or a family member covered on your plan.
3. SERVICES SUBMITTED BY
   This is who billed the service. Keep in mind that some providers belong to groups that bill for them, so you may not recognize the name.
4. CHARGES
   This is what your provider billed for the care you received.
5. NETWORK SAVINGS
   This is what you saved by using an in-network provider.
6. AMOUNT WE PAID
   This is the amount we have paid.
7. WHAT YOU OWE THE PROVIDER
   This is the amount you will pay your provider. You should get a bill from the provider’s office that shows the amount you owe.
8. DEDUCTIBLE STATUS
   This shows how much of the deductible has been met as of the date of this EOB.
9. DETAIL
   This area lists details for each claim shown in this EOB.
10. NOTES
    Notes show why we processed the claim the way we did.
11. APPEAL PROCEDURES
    Found on the back of the EOB, this section tells you how to appeal. You have the right to appeal any coverage decision we make.

Posted: June 28, 2021