What is an Explanation of Benefits (EOB)?
- Your Explanation of Benefits (EOB) outlines the costs for services you receive.
- An EOB is not a bill. You do not need to respond to this document. It is for your records only.
- Sign up to go paperless and we will notify you by email when a new EOB is ready.
- This is a summary of your visit, including the claim number.
- The amount that your doctor billed — what the price would be without insurance.
- The price Highmark Blue Shield of Northeastern New York has negotiated for you — the price with insurance.
- This is the amount of the bill that Highmark Blue Shield of Northeastern New York paid.
5. Copay: An amount you may be required to pay as your share of the cost for a medical service or supplies, or prescription drugs. A copay is usually a set amount, rather than a percentage
6. Deductible: The amount you must pay for health care or prescriptions before your insurance begins to pay.
7. Coinsurance: An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage.
8. The amount you are responsible for. You have either already received a bill from your doctor or medical facility for this amount, or will receive a bill.
Please note:
- There may currently be charges on your account that you are responsible for - things like copays, deductibles, coinsurance, or services not covered or excluded. If so, you have either already received a bill from your doctor or medical facility for this amount, or will receive a bill. Please refer to your most recent bill for any amounts currently owed.
- You may also get an Explanation of Payment — a document outlining claims you are being reimbursed for.
- The example provided above applies to non-Medicare members only. EOBs for Medicare members may look different.
- If you have further questions regarding your EOB document and want clarification, contact us to speak with a customer service representative. If you have questions regarding the status of your bill, contact your doctor's office or facility.