This article was last updated on Jan. 16, 2020.
Imagine yourself in this situation. You recently had medical care. Maybe it was some blood work or a minor surgery done inside your doctor's office. You know you used your health insurance benefits, but you're not sure how they applied or whether or not you owe your provider for the service.
Lucky for you, you'll soon receive your Explanation of Benefits (EOB). Don't worry — it's not a bill. Instead, it's a recap of what your insurance has paid for. It can help you understand how much your provider charged for your care, what Wellmark paid, and what you still owe for your service.
Your EOB is helpful, but it can also be a little confusing. Here's what you need to know.
How to read your EOB
We've made it easy to understand:
Patient account number
Your account number with your health care provider.
The total amount charged by a health care provider for services you received, whether or not the services are covered under your health plan.
The amount you saved by receiving services from a health care provider within your health plan’s network.
Amount paid by health plan
The amount paid to you or your health care provider.
The fixed dollar amount you pay for certain covered services before benefits are available. Your health care provider may bill you for these charges.
The fixed dollar amount you pay for certain covered services. Your health care provider may require this payment when you receive services.
The amount, calculated using a fixed percentage, you pay for certain covered services. Your health care provider may bill you for these charges.
Amount not covered
Other insurance paid
If you have coverage with another health plan, this is the amount that the other plan has agreed to pay.
Amount you are responsible for
Your share of the cost of the services shown on the EOB. You should use this information to coordinate your payment(s) with your providers.
The portion of the charges not covered under your health plan.
What do I need to do with my EOB?
You don’t need to pay anything when you receive your EOB. Because your EOB is not a bill, you don't need to pay anything when you first receive it. If your EOB shows that you are responsible for some of the cost, your health care provider will bill you. Once you receive the bill from your provider, compare the charges on the EOB to the charges listed on the provider bill to confirm that the services and charges listed are correct. If they aren't right, verify with your provider.
Rather receive your EOBs through myWellmark®?
If you're tired of the clutter that can come from paper EOBs, just update your preferences through myWellmark Opens New Window. When you choose to receive your documents online you can:
- Feel secure by viewing all your records in a single spot
- Stay updated through email notifications when you have a new statement available
- Switch back to paper anytime
Three easy steps to go digital
- Select My Account from the menu at the top.
- Click Edit under My Web Account.
- Under Information & Messaging make sure the button “I agree to receive important information about my plan electronically” is selected and Save Changes.