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Explanation of Benefits. Why read an EOB ? To make sure you are not paying more than you should. Did the insurance get the correct information and process.

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Presentation on theme: "Explanation of Benefits. Why read an EOB ? To make sure you are not paying more than you should. Did the insurance get the correct information and process."— Presentation transcript:

1 Explanation of Benefits

2 Why read an EOB ? To make sure you are not paying more than you should. Did the insurance get the correct information and process the claim correctly. Hospital bill is so much! Freaking out about how you are going to pay it, wait and read the EOB. The insurance needs more information to process the claim, look at the EOB to see what is needed. The provider is billing you the total amount and there is no EOB. Provider may not have the correct insurance information. If the provider was out of network the participant sends the claim to BCBS.

3 How the insurance works You go to a SERVICE PROVIDER (doctor, facility, lab, hospital, etc.) for services. The day you have the service done is the SERVICE DATE. The service provider sends you a bill and sends the detailed information (procedure codes) to the insurance (Blue Cross Blue Shield - BCBS). BCBS looks at your medical plan summary to determine how much you and BCBS owe the service provider. This information is sent to you and the provider at the same time in the form of the EOB. The provider sends you another bill updated with information from the EOB. You receive the EOB through the mail and its also online at bcbstx.com. Use the service date, service provider and original charge amount to match the EOB with the provider bill.

4 Is the EOB correct or is further action needed? Plan summary – (small sample) Plan summary – Recommend printing and keeping with your bills / Benefits / Benefits / Frog Life / Benefits / Health Insurance Information / Click on the medical plan you are on bcbstx.com – See all your EOBs that BCBS has bcbstx.com EOB – your received in the mail EOB

5 Plan Summary

6 Plan Summary 1 of 5

7 Plan Summary 2 of 5

8 Plan Summary 3 of 5

9 Plan Summary 4 of 5

10 Plan Summary 5 of 5

11 RETURN

12 BCBSTX.com 1 st time - Log In – dont forget to write down and save you user name and password! After the first time click on enter your user name and password. Who is covered on your medical insurance Download claim forms Print temporary ID cards and request ID cards Find a Doctor, Hospital, or other Medical Facilities Click on tab Already a Member? Visits & Claims

13 You

14 Medical Claim Summary view

15 Sample EOB deductible

16 Summary of claims / EOBs View

17 Sample EOB 1

18 Sample EOB 2a

19 Sample EOB 2b

20 Sample EOB 2c


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