How Do I Read My Explanation of Benefits?

Want to know about the forms you get in the mail that LOOK like a medical bill but aren't? Those explanations of benefits are important for understanding your coverage.

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Show Transcript

JOSEPH: Hi! My name is Joseph and today I'm meeting with a Blue Cross and Blue Shield customer advocate to talk about... how to read my explanation of benefits. I went to the doctor a few weeks ago and today I got a letter in the mail about my visit. It looks like a bill but it says explanation of benefits. What is that?

BCBS ADVOCATE: I'm glad you asked. Your explanation of benefits or EOB is an important record of your health care services and benefits. It helps you know what fees were billed by your doctor, what benefits were approved under your plan, any discounts you may get for being a Blue Cross and Blue Shield member, and how much money you owe your provider.

JOSEPH: Oh, so it is a bill?

BCBS ADVOCATE: No. You're EOB isn't a bill but it does show how much your provider can charge you. Let's take a look. At the top you have the total of claims section. It may include multiple claims together if you have more than one. It gives you a quick view of the amount you may have to pay your provider.

JOSEPH: So, that should match what my doctor charges?

BCBS ADVOCATE:  Right. Always compare your EOB to your bill to make sure you're being charged the right amount. Keep in mind; you might have paid a copay
at the time of your visit.

JOSEPH:  That's a great tip. I'll remember that. But what about all these other numbers?

BCBS ADVOCATE:  The middle section shows your service details. It describes each service you received, the day you had the service, your doctor or facility name, and other charges. Then it shows your discounts and costs for each service. If something isn't covered you'll also see it here. And there will be an explanation for why it wasn't covered.

JOSEPH:  That's really good information to know. What about this bottom part?

BCBS ADVOCATE:  The summary section at the bottom totals up all the covered charges for each claim and shows you how much of the cost goes towards your deductible, your copay, and your coinsurance.

JOSEPH:  Okay, I think I've got it now. So besides the checking amount I owe is there anything else I need to do with the EOB?

BCBS ADVOCATE:  Look it over to make sure all the information is correct. If you find an error call your doctor's office. They may need to resubmit a claim with the correct information. If you think you've been charged for services you didn't receive call the fraud hotline number. Once you reviewed your EOB you should also store them in a safe place with your records.

JOSEPH:  Oh! I've been throwing them away. I'm not great with paper.

BCBS ADVOCATE: That's okay. You can sign up for paperless EOB's on Blue Access for Members. You can view them online for up to 18 months and save them for your records. You can also view them on our mobile app.

JOSEPH:  That's great news! I'll sign up right now.

BCBS ADVOCATE: And if you have more questions about your EOBs you can call the number on your member ID card.

JOSEPH:  Thank you.        

BCBS ADVOCATE: No problem.

SPEAKER: For more information call the number on your member ID card or visit our website at

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