administrativemy

ExplanationofBenefits(EOB)ReferenceguideHowmuchdoIoweforamedicalclaimWeknowthathealthcarebillscanbeconfusing.
WewanttohelpyouunderstandwhatEOBsareandhowtheyhelpyoukeeptrackofyourmedicalclaims.
WemailyouanEOBwhenaprovider(doctor,hospitalorotherhealthcarefacilityorprofessional)filesaclaimforyourcare.
TheEOBisnotabill.
Itshowshowyourclaimisprocessedandhowyourbenefitswork.
Foreverydoctorvisitorservice,yourEOBtellsyouhowmuchwepayandhowmuchyouowe.
YoumaynotalwaysgetanEOBinthemail.
Forexample,ifyouonlyneedtopayacopayforaservice,wewon'tmailyouanEOB.
ButyoucanstillviewyourmedicalEOBs/claimsrecapsonlineatanthem.
com.
YoucanevenchoosenottogetyourEOBsbymailandjustviewthemonline.
Here'show.
1.
Logintoanthem.
com.
Ifyouhaven'tregisteredyet,you'llneedtoregistertologin.
2.
ClickonProfile.
3.
Scrolldowntochoosehowyou'dliketogetyourEOBs/claimsrecaps.
ChooseGoPaperless.
(Onlythesubscribercanpickthisoption.
)It'sfinetopayyourcopayduringyourdoctorvisit.
Butifyougetabillinthemail,checkyourEOBbeforeyoupay.
Anthemmayhavealreadypaidfortheservice.
13494OHMENABS(NASCO)Rev.
12/11AnthemBlueCrossandBlueShieldisthetradenameof:InColorado:RockyMountainHospitalandMedicalService,Inc.
HMOproductsunderwrittenbyHMOColorado,Inc.
InConnecticut:AnthemHealthPlans,Inc.
InGeorgia:BlueCrossandBlueShieldofGeorgia,Inc.
InIndiana:AnthemInsuranceCompanies,Inc.
InKentucky:AnthemHealthPlansofKentucky,Inc.
InMaine:AnthemHealthPlansofMaine,Inc.
InMissouri(excluding30countiesintheKansasCityarea):RightCHOICEManagedCare,Inc.
(RIT),HealthyAllianceLifeInsuranceCompany(HALIC),andHMOMissouri,Inc.
RITandcertainaffiliatesadministernon-HMObenefitsunderwrittenbyHALICandHMObenefitsunderwrittenbyHMOMissouri,Inc.
RITandcertainaffiliatesonlyprovideadministrativeservicesforself-fundedplansanddonotunderwritebenefits.
InNevada:RockyMountainHospitalandMedicalService,Inc.
HMOproductsunderwrittenbyHMOColorado,Inc.
,dbaHMONevada.
InNewHampshire:AnthemHealthPlansofNewHampshire,Inc.
InOhio:CommunityInsuranceCompany.
InVirginiaAnthemHealthPlansofVirginia,Inc.
tradesasAnthemBlueCrossandBlueShieldinVirginia,anditsserviceareaisallofVirginiaexceptfortheCityofFairfax,theTownofVienna,andtheareaeastofStateRoute123.
InWisconsin:BlueCrossBlueShieldofWisconsin(BCBSWi),whichunderwritesoradministersthePPOandindemnitypolicies;CompcareHealthServicesInsuranceCorporation(Compcare),whichunderwritesoradministerstheHMOpolicies;andCompcareandBCBSWicollectively,whichunderwriteoradministerthePOSpolicies.
IndependentlicenseesoftheBlueCrossandBlueShieldAssociation.
ANTHEMisaregisteredtrademarkofAnthemInsuranceCompanies,Inc.
TheBlueCrossandBlueShieldnamesandsymbolsareregisteredmarksoftheBlueCrossandBlueShieldAssociation.
ThisguidewilltakeyouthroughtheelementsoftheEOB.
1.
Patient'sName:thepatientwhoreceivedtheservices.
2.
ProviderName:theprovider(e.
g.
,doctor,hospitalorlaboratory)oftheservicesforthepatient.
Theprovidernamemaynotbeyourdoctor'sname.
That'sbecauseservicessuchastests,X-raysandconsultationsmaybedonebyotherhealthcareprovidersasdirectedbyyourdoctor.
3.
ClaimNumber:thenumberassignedtothepatient'sclaim.
4.
ServiceDate:whentheservicewasreceived.
5.
Description:ashortdescriptionoftheservice.
6.
AmountCharged:theamountbilledbytheproviderwhoperformedeachservice.
Note:IfMedicare/complementaryservicesareinvolved,theamountinthiscolumnwillrepresenttheamountbilledtoMedicare.
7.
AllowableCharges:thepricewehaveapprovedforthatservice(includesanydeductible,coinsuranceorothermemberexpenses).
8.
OtherInsurance:theamountpaidbyotherinsurance,includingMedicare.
9.
AppliedtoDeductible:whatwasconsideredpartofyourdeductible(theamountyoumustpayforcoveredhealthcarecostsbeforeyourbenefitsarepaid).
Youareresponsibleforthisamount.
10.
Copay:theamountyoupayforeachdoctorvisitorcoveredservice.
Youareresponsibleforthisamount.
11.
Coinsurance:ashareofthecost(allowablecharge)thatyoumustpayforeachserviceafteryouhavepaidyourdeductiblefortheyear.
Youareresponsibleforthisamount.
12.
OtherAmountsNotCovered:costthatexceedsyourbenefitsorcostforservicesthataren'tcovered.
Youmayberesponsibleforthisamount(plusanydeductible,coinsuranceorcopay).
13.
AmountPaid:thetotalamountpaidtoyouoryourprovider.
14.
Code:codesthatreferyoutospecificmessagesatthebottomofthechart.
Thesemessagesexplainapaymentsituationorwhyyoumayberesponsibleforaservice.
15.
ID#:themembernumberofthesubscriber/employee.
ThisisalsothenumberonyourAnthemIDcard.
Pleaserefertothisnumberwhenyoucallorwritetous.
16.
Group#:thenumberoftheaccountinwhichyouareenrolled.
17.
Messages:moreinformationabouttheclaim.
18.
AddressandPhone#:wheretowriteorcallifyouhavequestions.
19.
YourLiability:Thissectionidentifiesabreakdownofwhatthememberisresponsibleforpaying.
20.
YourTotalLiability:Thissummarizesthetotalofthe"yourliability"columns.
Note:TheEOBgrandtotalsummarycanbefoundattheendofthedocument.
21.
Anti-fraudtoll-freehotline:thenumberyoucalltoreportfraud.
22.
OtherLanguagesAvailable:whenmandated,messagesinaforeignlanguagewillbenotedatthebottomoftheEOB.
23.
StatementDate:whentheEOBwasgenerated.
ANTHEMBLUECROSSANDBLUESHIELD12345MAINSTREETANYTOWN,USA,912345000012345678910002389293945YOURNAMEADDRESSCITY,STATE,ZIPThisstatementreportsonclaim(s)recentlyprocessedforyouand/oryourdependents.
FormoredetailslogontoAnthem.
com.
Ifyouhaveanyquestions,pleasecallorwrite:ANTHEMBLUECROSSANDBLUESHIELD12345MAINSTREETANYTOWN,USA,9123451-888-123-4567Anti-fraudtoll-freehotline:1-800-848-9276ExplanationofBenefitPaymentsTHISISNOTABILLL1234545678000001200001/000021821statementdate:ID#group#yourliabilityServiceDateDescriptionAmountChargedallowablechargesotherinsuranceappliedtoDeductiblecopaycoinsuranceotheramountsnotcoveredAmountPaidCodePatient:Provider:Claim:Totals–1345678912101114213191615SEEBACKFOREXPLANATIONOFCOLUMNS1722MessagesOtherlanguagesavailableYOURTOTALLIABILITYONTHISCLAIMIS$0.
00(Z031)2023