Reading Your Explanation of Benefits (EOB)
Your Explanation of Benefits (EOB) is a simple recap of how your health plan paid for medical care or services you received. You'll get one after every visit to a care provider. You may get multiple EOBs for some services, like surgeries. It's important to know your EOB is not a bill.
Reviewing your EOB
Below is an example of an EOB. Your statement can be broken down into three important sections:
The EOB statement shows how your health plan applies coverage to claim(s) by date of service. The EOB is broken down into 3 main sections. Section 1 shows date of service, patient account number and health care provider, and claim number and type of service. Section 2 shows the amount charged, your network savings by seeing a doctor in-network, and the amount paid by your health plan. The 3rd section shows the amount you are responsible for broken down by deductible, copayment, coinsurance, and the amount not covered. The amount you are responsible for is shown clearly underneath this 3rd section.
Every EOB includes information about your claim, including the patient, date of service, provider and the type of service received.
Your EOB may include information about more than one claim or more than one patient.
This section will help you understand how Wellmark covered the cost of your service or visit.
You'll see the Amount Charged Glossary popover by your provider, how much you saved by staying in-network in Network Savings Glossary popover and the amount your plan paid toward the service or visit, which is known as Amount Paid by Health Plan Glossary popover.
Based on your specific plan, you may be responsible for part of the cost in the form of a deductible, copayment, or coinsurance. There may also be services that aren't covered or some costs that are covered by other insurance.
The sum of your Deductible Glossary popover + Copayment Glossary popover + Coinsurance Glossary popover + Amount Not Covered Glossary popover is the amount you may owe your provider. If you haven't already paid it, your provider will send you a bill separately.
It's important to remember your EOB is not a bill, and you shouldn't pay anything to Wellmark when you receive your EOB.
How to get your EOB
You can easily track, sort and review your EOBs by date, provider or patient through the secure member portal, myWellmark®. Your online account will keep all those records safely stored for 24 months.
To start receiving an email notification when a new EOB is posted, simply register and log in to myWellmark and follow these three easy steps:
- On the Profile page, click the Notifications tab.
- Choose Email for Explanation of Benefits (EOB), then Agree and Save.
