Read Your Explanation of Benefits!

Has this happened to you? Your insurance company sends you a statement in the mail about a medical claim and you’re left wondering if that’s what you owe or if you’re supposed to ignore it.
 
Don’t ignore it!

What you likely received was an Explanation of Benefits (EOB) – not a medical bill. And the more you understand how to read it, the better you can protect your rights and your pocketbook.
 
An EOB is a statement that is mailed to you or posted online after your medical claim is settled. It provides you with details about your claim.

How to Read Your EOB
Each EOB features information about the service that was provided. The parts that will help you know what you might owe include:

• The billed charges – What your provider charged for the services.
• Discount amount and code – If the full cost of your service is not covered, the discounted amount and reason for the discount taken. Often this is the negotiated PPO price for the services you received.
• Not eligible – The dollar amount not covered by your plan.
• Total eligible – The total expense that is eligible for benefits under your health plan.
• Member responsibility – Your portion of the costs for service after the plan has paid benefits.

 
You typically are not required to pay the difference between what your provider billed and the discounted amount paid by your insurance company.
 
If you receive a bill from your provider that your EOB shows is an amount due greater than your “member responsibility,” call your insurance company. This is called a balance bill and you will need to find out whether you will be responsible for that amount or whether your insurance company will handle it.
 
Read your EOB and protect yourself from unnecessary bills.

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Allied National

Founded in 1970, Allied is one of the nation's oldest and most experienced third-party administrators. Allied National is a 90 Degree Benefits Company, a subsidiary of Blue Cross Blue Shield of Alabama. As the small group benefit experts, Allied works with small business employers to provide unique and affordable group health benefits.