Understanding Your EOB

Learn more about what the information in an EOB means.

Each time a claim is processed, Horizon BCBSNJ generates an EOB statement. The EOB gives you important information about the claim, including:

The amount your plan allows for the treatment, service or device
How much your plan paid
How much you owe, if applicable

TRANSCRIPT

[A cartoon character is shown on screen. He is the narrator in this video.]

An Explanation of Benefits, or EOB, is a paper or electronic document you receive after you see a doctor or other health care professional, or get medical services or equipment. You’ll find information about your claims, payment information and more.

Your EOB helps you understand how your plan pays claims so you know what was paid by Horizon Blue Cross Blue Shield of New Jersey, and what, if anything, you owe.

Now, let’s learn more about your EOB. In this example of an EOB, you will see:

[A blank EOB document is displayed. As the narrator describes each section of the EOB, the section is added to the EOB document.]

Date of Service: This is the date services were provided to you.
Type of Service:which gives a brief explanation of each service provided.
Billed amount: The full amount charged by the doctor, other health care professional or facility for each service.
Allowed amount: The amount Horizon BCBSNJ approved for payment based on your plan benefits prior to the deductible, coinsurance, copayment or other member cost sharing, if applicable.
Your coinsurance or copayment amount: The amount you pay to the doctor, other health care professional or facility after you have met your deductible, if applicable.
Your deductible amount: The amount you are responsible for paying to the doctor, other health care professional or facility for the service provided before your insurance begins to pay for eligible services.
Other carrier payment amount: The amount paid by another insurance carrier, if applicable.
Not covered amount: The amount charged for the service that is not covered by your plan. This can be for expenses not covered or in excess of your benefits. This amount may be in addition to any deductible, coinsurance or copayment.
Horizon BCBSNJ paid amount: The total amount paid to you, your doctor, other health care professional or facility for the services performed.
Message code: This shows the codes explaining how payment was calculated.
Subscriber responsibility: The amount you owe the doctor, other health care professional or facility, including any copayment, deductible or coinsurance, if applicable.

You can also view, save and print your EOB by signing into Member Online Services at HorizonBlue.com and clicking Claims.

To learn more, visit HorizonBlue.com/eob. Thank you for viewing.