Explanation of Benefits


Your Explanation of Benefits (EOB) can help you see how your claims have been processed.

Simply put, an Explanation of Benefits, or EOB, is a paper or electronic document you’ll receive after you see a physician or other health care professional, at the time your claim is processed. On the EOB you’ll find claims and patient payment information for you and your covered family members in a single statement.

Part of making the most of your health care coverage is understanding how your plan pays your claims and what your role is in that process. The EOB we provide to you is a straightforward way to see this information in one place and use it to track your health care services or expenditures.

The sample EOB below provides an overview of the information you’ll see and what it means to you. You can also sign in to view and print your own EOBs.

A sample explanation of benefits document

A

Date of Service

The date that services were provided to the patient.

B

Type of Service

A brief explanation of each service.

C

Billed Amount

Amount charged by the doctor, health care professional or facility for each service on the claim.

D

Allowed Amount

The amount we approved for payment based on your plan benefits prior to the deductible, coinsurance, copayment or other member cost sharing, if applicable.

E

Your Coinsurance/Copayment Amount

The coinsurance or copayment amount which is your responsibility after you have met your deductible, if applicable. You pay this amount to the doctor, health care professional or facility.

F

Your Deductible Amount

The amount applied for this service under your benefits contract. You are responsible for paying this amount to the doctor, health care professional or facility.

G

Other Carrier Payment Amount

The amount paid by another insurance carrier, if applicable.

H

Not Covered Amount

Any amount of the fee charged for the service that is not covered by your plan; expenses not covered or in excess of your benefits. You may be responsible for this amount in addition to any deductible, coinsurance or copayment. When using an out-of-network doctor, health care professional or facility, the costs above the negotiated rate of an in-network provider will appear here.

I

Horizon BCBSNJ Paid Amount

The total amount paid to you, your doctor, health care professional or facility for the services performed.

J

Message Code

These codes refer to specific messages below each claim that help explain how we calculated our payment.

K

Subscriber Responsibility

The amount you owe the doctor, health care professional or facility. This includes any copayment, deductible or coinsurance, if applicable. For out-of-network services, the difference between billed and allowed amounts is included here.