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IBX Insights

Your Explanation of Benefits (EOB), Explained

By May 24, 2018December 31st, 2020Benefits Health Insurance Member Resources

You found a doctor, made an appointment, received care, and picked up your prescriptions. A few weeks later, you get a letter or an email from Independence with a document that says, in all capital letters, “THIS IS NOT A BILL.” So if it’s not a bill, what is it?

Meet your EOB

Your Explanation of Benefits (EOB) — also called a Plan Activity Statement — breaks down the exact costs every time you receive care. You’ll see how much the provider charged, what your health plan covered, and how much (if anything) you’ll pay out of pocket.

Here’s what you’ll find in an EOB:

  1. The provider or facility where we sent payment for your care.
  2. The amount of money the provider charged for your care.
  3. The difference between the provider’s charge and our allowance. You are not responsible for this amount.
  4. Amount covered by Independence.
  5. The amount Independence pays.
  6. The total of all member responsibilities. This includes any deductible, coinsurance, or copayment amounts, plus any remaining amount.
  7. Explains why certain charges (if any) were not covered.

Please note that your EOB may contain different billing categories, depending on the type of health plan you use. These may include:

Your Copay: A copayment, or copay, is the fee you pay when you see a doctor or get other covered services.

Your Deductible: The amount you pay each year before your health plan starts paying for covered services.

Your Coinsurance: The percentage you pay for some covered services. If your coinsurance is 20 percent, your health insurance company will pay 80 percent of the cost of covered services, and you will pay the remaining 20 percent.

FAQs about EOBs

What should I do if I owe money for my care?

If you owe anything out of pocket, your provider will send you a bill.

Can I find my EOBs online?

Yes! Here’s how:

  1. Log in to ibxpress.com.
  2. Select CLAIMS & SPENDING in the menu bar, then My Claims Overview.
  3. Select a claim to view the EOB.

Can I change how I receive my EOBs?

You can choose to receive your EOBs by email or regular mail:

  1. Log in to ibxpress.com.
  2. Select ACCOUNT SETTINGS from the top of the page.
  3. Scroll down to COMMUNICATION PREFERENCES and select Edit.
  4. As shown below, you can opt to receive your EOB as an email or by regular mail.

What should I do if I have questions about my EOB?

If you have any questions about your EOB, call the number on the back of your member ID card. Be sure to have your member ID card and the EOB handy when you call.

 

Paula Sunshine

About Paula Sunshine

Paula Sunshine is senior vice president and chief marketing executive at Independence Blue Cross. She oversees all commercial and consumer marketing activities, including digital assets such as ibx.com and the IBX mobile app. Ms. Sunshine earned a bachelor of arts degree in mathematics from Emory University and a master of business administration from the Wharton School at the University of Pennsylvania.