Understanding Your Explanation of Benefits

Your explanation of benefits (EOB) shows your medical claims and payments made by your health benefit plan. You’ll receive an EOB after you see your doctor or have a test done.

This guide will help you understand your EOB and all the information on it. Each numbered definition below corresponds to one of the numbers on the sample EOB on the following pages.

Sample Explanation of Benefits

The items appearing on the explanation of benefits (EOB) sample are for reference only. This sample shows claims and benefits for a family of five. Each family member’s claims are shown separately.

1 - Group Number

Number assigned to your employer

2 - Print Date

Date the EOB was issued

3 - Patient Name

Name of person who received care

4 - Type of Service

Description of the visit (e.g., physician visit)

5 - Claim Number

Identifies the claim in our system

6 - Service Date

The date you received care

7 - Billed Charges

Services that have been billed to your health benefit plan

8 - Discount Amount

The amount that has been reduced from the provider

9 - Other Adjustments

Negotiated or ineligible amounts that are not your responsibility

10 - Other Plan Payment

A payment made by another health plan due to coordination of benefits

11 - Ineligible

Amount of submitted charges not covered by the plan

12 - Copay

A predetermined charge that the provider can collect from you at the time of service

13 - Deductible

The amount of the covered charge that you are responsible for paying before your health plan starts sharing costs

14 - Co-Insurance

A percentage of the covered expenses you are responsible for paying

15 - Plan Benefit

Total amount your plan will pay for the submitted charge(s)

16 - Plan Paid At

Percentage of the covered expense paid by your plan, after any applicable deductible

17 - Reason Codes and Code Explanations

Used to explain why a portion of submitted charges is not covered by the plan. A number, or reason code, shown on the EOB corresponds with an explanation. (See page 2 of sample.)

18 - Patient Account Number

Account number assigned by the facility or provider

19 - Provider

Name of facility or provider

20 - Issued

Date the claim was released and sent to processing

21 - Patient Responsibility

The total you are responsible for paying

22 - Family

Dollars applied toward the employee and covered dependents

23 - Current Year

Benefit payments made during this year

Depending on how the claim was paid, these items may appear differently. The claim will be paid with in-network or out-of-network rates. These items will include payments toward your deductible, out-of-pocket costs, and lifetime medical maximum allowance.

Questions about your EOB? Contact Bryan Health Direct at the number on your ID card.

R006-178_BHD (11-23)