How much was paid on my claim and what do I owe?
Your Explanation of Benefits (EOB) gives you an overview of the claim, including who provided the care, how much was billed, how much your plan covered, and how much you may owe.
Your EOB gives you detailed information about your claim. It tells you how much you are responsible for paying as a copay, coinsurance or deductible.
It also lists any “Amount Not Covered,” which may be costs billed by your doctor that are not covered by your plan.
All of these amounts are included in “What You Owe.”
Remember: Your EOB is not a bill, so don’t take out your checkbook just yet. Wait until you get a bill from your doctor to pay exactly what you owe.
Terms used in an EOB
- Date of Service: The date you received your care.
- Type of Service: The service or care given to you by the provider.
- Amount Billed: The amount charged by the provider for each service on the claim.
- Allowed Amount: The amount the provider agrees to be paid for a specific service. It may include a deductible, coinsurance and/or copay.
- Your Plan Paid: The total amount paid by Horizon BCBSNJ to you or the provider for the services that were covered by the plan.
- Your Other Insurance Paid: The amount paid by another insurance carrier, if you are covered under another health insurance plan.
- Copay: A copay is a fee that you pay each time you go to the provider. You pay the copay at the time you receive the care or service.
- Coinsurance: The coinsurance is the amount you pay out-of-pocket after you have paid your deductible, if any. You pay the coinsurance amount directly to the provider.
- Deductible: The amount you must pay before your plan pays for covered services. You are responsible for paying this amount directly to the provider.
- Amount Not Covered: The fee charged for care that is not covered by your plan. You may be responsible for paying this amount in addition to any deductible, coinsurance and/or copay.
- What You Owe: The total amount you owe the provider. The total amount includes:
- Any copay, coinsurance and/or deductible
- Costs for services you receive that are not covered by your plan
- The difference between the billed and paid amounts for out-of-network services
- Claim Detail: These codes refer to specific messages for each claim that help explain how we processed your claim and calculated any payment.