"RBS How to read an EOB"
Explanation of Benefits How to read an EOB After each visit to a doctor, hospital or other caregiver, Regence will send you an Explanation of Benefits (EOB). This isn’t a bill. Rather, it describes what part of the caregiver or hospital bill Regence paid directly to the provider, and what part (if any) is your responsibility. Later, when the doctor or hospital bills you, it’s a good practice to compare that bill with the EOB to make sure the amounts due agree. If they do, then you can go ahead and pay the provider from the doctor or hospital bill. If you have questions about something on an EOB, or if you disagree about how a claim was paid, call Re- gence at the telephone number shown on your EOB. We hope the following diagram will help you read your EOB. 1 PAYMENT SUMMARY Gives a quick sum- FRONT mary of the total charges for treatment, how much Regence paid, and how much (if any) the member is responsible for paying. 2 CHARGES What the health-care provider charged for the services listed. 3 ALLOWED AMOUNT The amount pro- viders have agreed to charge Regence 1 members. This amount is usually less than the total charges. Members do not have to pay the difference. 4 DEDUCTIBLE/COPAY The amount mem- bers are expected to pay up front before coverage begins. Deductibles must be sat- isfied annually; copays are usually charged 3 4 5 6 2 per visit. 5 BENEFIT PERCENTAGE Also known as coinsurance, this is the percentage that Re- gence covers. The member is responsible 7 for the balance of the allowed amount. 6 PAID AMOUNT The actual dollar amount Regence paid to the provider. This amount 8 should show as a credit on the doctor or hospital bill if the provider bills the mem- ber for any part of the bill the member is responsible for. 7 EXPLANATION MESSAGE CODES These codes explain how Regence processed the claim. 8 PATIENT RESPONSIBILITY INFO This section lists any amounts not covered by 9 Regence that the member should pay directly to the provider when they receive a bill from the doctor or hospital. 9 TELEPHONE NUMBERS Numbers to call if you have a question about this Explanation of Benefits. (over) BACK 10 BENEFIT SUMMARY Shows how much has been applied to the member’s annual de- ductible and how much more the member will spend out-of-pocket before the plan’s stop loss limit is reached. 11 CLAIMS REVIEW Explains the member’s rights if they disagree with the way a claim has been paid. 10 11