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Understanding Your Explanation of Benefits

Learn more about your claims statement.

 

General Explanation of Benefits Questions

Online Explanation of Benefits Questions

General Questions

Q. What are Explanation of Benefits?

A. Explanation of Benefits are statements that show how your health benefits were applied to your claims processed by Wellmark. You receive an Explanation of Benefits statement from Wellmark whenever a claim for your health care benefits has been processed. It is not a bill. You will receive a bill from your provider for the amount you may owe.

How to Read Your EOB pdf (1.08MB)

 

Q: Why should I pay attention to my Explanation of Benefits?

A. It is important to compare charges on your Explanation of Benefits to charges listed on health care provider bills to confirm that services you received and charges listed are correct.

 

Q: What does amount charged mean on my Explanation of Benefits?

A. Amount charged is the total amount charged by a health care provider for services you received. The charges for all of the services you received at that visit will be listed even if the services are not covered under your health plan.

 

Q: What is network savings on my Explanation of Benefits?

A. Network savings is the amount you saved by receiving services from a network or contracting health care provider.

 

Q: What is amount paid by health plan on my Explanation of Benefits?

A. Amount paid by health plan is amount Wellmark pays either you or the provider.

 

Q: How can the amount paid by Wellmark be more than what the provider charged?

A. For inpatient and outpatient services, Wellmark pays a preset amount. Since the price is pre-determined, Wellmark occasionally pays the facility more than the facility charged. Usually this occurs because your care was well-managed. Facilities prefer per case payments because it gives an opportunity for reward when it does a good job of managing your care. Wellmark Blue Cross and Blue Shield prefers per case payments because it helps control costs by encouraging efficient delivery of health care services. 

 

Q: Are my rates going up because Wellmark is paying more than what the provider charged?

A. No, paying greater than what the provider charged is not why your health insurance rates are going up. Paying more than the facility charged does not happen very often. When it does occur, it is usually because your care was well-managed. At the end of the day, the overall savings from paying a preset amount far outweighs those times when we pay more than the provider charged. Learn more about paying greater than charge pdf

Online Explanation of Benefits Questions

Q. How are online Explanation of Benefits different from paper Explanation of Benefits?

A. The actual Explanation of Benefits is the same. The only difference is in the way you receive your Explanation of Benefits online — instead of by mail.

 

Q. Why should I move to online Explanation of Benefits?

A. There are many benefits to receiving your Explanation of Benefits statements online:

  • Helping the Environment — Wellmark prints and mails approximately 12 million statements a year. That's a lot of trees.
  • Quick notification — An email notification is sent directly to you when an Explanation of Benefits is available.
  • Convenience — Wellmark will store your statements up to 24 months after the initial sign-up. This provides a safe and convenient way to access and view your statements.
  • Planning and budgeting — Use your online statement to help with health care budgeting and flexible spending accounts. 

Q. Who can sign up to receive online Explanation of Benefits?

A. You must be the policyholder on your Wellmark health plan policy to sign up to receive Explanation of Benefits online. Spouses and dependents cannot sign up to receive these statements online.

 

Q. How do I move to online?

A. The first step is to register for Wellmark.com. Be sure to select "I wish to receive my Explanation of Benefits (EOBs) online" when you register.

 

If you're already registered, log in padlock and go to My Web Account under My Account, and change your setting to online.

 

Q. What if I change my mind and want to go back to paper Explanation of Benefits?

A. You can move back and forth between paper and online at any time by selecting My Web Account under My Account when you log in to Wellmark.com. Please note: If you switch to paper, you will no longer have access to your Explanation of Benefits online. This includes those which were previously viewed online.

 

Q. Can anybody on my policy view Explanation of Benefits?

A. Only the policyholder can view these claims statements.

 

Q. What if I'm registered for Wellmark.com, but I can't remember my user ID or password?

A. You can use the Forgot User ID or Password? link on Wellmark.com to retrieve your login information. If you need assistance with registering or logging in, please contact Wellmark's technical support team (EC Solutions) at 800-407-0267 from 7 a.m. to 5:30 p.m., Central time, Monday - Friday.

 

Q. How will I know I have an Explanation of Benefits to view?
A. You will receive an email alert when a new Explanation of Benefits statement is available to view.

 

Q. Can I view an Explanation of Benefits online for prescriptions? 

A. Pharmacy services are paid at the time you fill your prescriptions, so Explanation of Benefits are not issued. However, if you are registered on Wellmark.com, you can view your pharmacy claims. Pharmacy services included in your health benefits will be reported on your Explanation of Benefits. 

 

Q. Can I view an Explanation of Benefits online for my dental services?

A. Dental services are processed by either Blue Dental (Iowa) or Delta Dental (South Dakota). Online Explanation of Benefits are not available at this time for dental services. For more information, call Blue Dental (Iowa) at 877-333-0164 or Delta Dental (South Dakota) at 877-841-1478. If you sign up for online Explanation of Benefits, you will still receive paper statements for your dental claims.

 

 



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