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What is an Explanation of Benefits (EOB)?

Your EOB or Explanation of Benefits 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.

After you visit a doctor, other health care professional, laboratory or hospital, an EOB is generated for you. If your health care provider participates in Horizon’s networks, the claim is submitted to Horizon for you. But if you go to an out-of-network health care provider, you may need to submit the claim yourself.

An EOB is not a bill. It tells you what costs are covered for medical care or services you’ve received.

Understanding Your Explanation of Benefits

Video Transcript

[“Understanding Your Explanation of Benefits” title and Horizon Blue Cross Blue Shield of New Jersey logo]

Each time you use your health plan to get care, you’ll get information about the claim your doctor submitted.

This information is called an “Explanation of Benefits” or EOB.

Your 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 also gives you detailed information about your claim.

This section lists additional information, including other insurance plan payments, if you have other coverage, and 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.

You can view your EOBs, 24/7, by signing on to HorizonBlue.com or the Horizon Blue app.

If you have a question about your benefits or your EOB, sign in to HorizonBlue.com to email your question or chat with us, or give us a call. [1-800-355-BLUE (2583)]

To learn more, visit “What Happens After My Appointment” at HorizonBlue.com. [HorizonBlue.com/AfterMyAppointment]

[Horizon Blue Cross Blue Shield of New Jersey logo and disclaimer]

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Last updated:

Jan 07,2022

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