After you receive healthcare services and a claim is processed, you’ll receive a document that explains the services you received and how your benefits were applied. This breakdown is called an Explanation of Benefits (EOB). You can view your EOB online in Blueprint Portal or choose to receive it by mail or email.
An EOB reflects the total cost of the care you received, how your health insurance was applied, any discounts you received, what the health plan paid, and what costs (if any) you may still owe to your provider.
Although it includes a cost breakdown, an EOB is not a bill. It is a simple way for you to view all your claims for a given period and see how your insurance is being applied.
EOB Terms Explained
An EOB from Arkansas Blue Cross and Blue Shield, and its family of companies, will include a summary page followed by a detailed breakdown of each claim for that period.
(Keep in mind, EOBs can look different from one health insurance company to the next, so this guide will not be comprehensive for every EOB.)
The summary page is an overview of the totals for all claims reflected in that EOB. This includes:
- Total charges: The full amount providers charged for the services, treatments, devices or drugs.
- Member discount: Discounts are negotiated with in-network providers. As a member, you get the benefit of these negotiated rates. Out‑of‑network providers don’t offer member discounts, so your plan pays part of the bill and you may have to pay the rest.
- Your plan(s) paid: The amount paid by your benefit plan, based on the terms of your plan.
- Your responsibility to provider(s): Providers can bill you for this amount if you have not paid.
Next, you will see detailed pages with a line-by-line breakdown for each claim. The claim details are grouped into three main categories: the amount charged, the amount your plan(s) paid and your responsibility.
This page also includes the individual claim number for each claim. This is the unique ID assigned to each claim that we process for a specific visit, service, or procedure. Customer service may ask you for this number when you call, so they can answer your specific questions for that particular claim.
The first group of columns includes information about the charge amounts.
- Provider billed: The amount the provider charged for the services provided.
- Member discount: See definition above.
- Net charged: For in-network services, this is the remaining balance after your member discount is deducted.
The second group of columns includes any adjustments made and what your plan(s) paid.
- Provider adjustment: The amount the doctor or hospital agreed not to be bill under their contract. . You cannot be billed for this amount.
- Other health plan coverage: The amount paid by any other health plan coverage you have (if applicable).
- Your plan paid: See definition above.
The third group of columns includes amounts you are responsible for paying and the type of expense.
- Copay: The fixed amount you may be required to pay for some covered healthcare services. This is often paid at the time of the service. The amount varies based on plan and type of visit. (Copays are different from coinsurance, which you’ll see later in your EOB.)
- Deductible: The portion of the covered expense you pay out-of-pocket before your health insurance begins to pay its share of covered expenses.
- Coinsurance: Once you meet your deductible, your insurance begins to pay for part of your in-network visits. For example, you may pay 20%, and the health plan pays 80% (exact percentages depend on your plan).
- Excluded: Services that are not covered under your benefit plan.
- Total: The final amount you are responsible for paying for that service.
These definitions are also listed on your EOB for quick reference.
When reading your EOB, review the numbers line-by-line from left to right starting with the amount the provider billed. Each column shows how discounts, payments and plan benefits affect the final amount you may owe.
Want to receive your EOBs by email instead of by mail? Go paperless at blueprintportal.com/paperless.
What if my EOB is wrong?
Always compare your EOB to the bill you receive from your provider. If the amounts don’t match, call the number on the back of your member ID card or contact your provider for help.
Where can I find my deductible and out‑of‑pocket totals?
Your EOB shows how your plan applied your benefits for that specific claim, but it does not include your total deductible or out‑of‑pocket (OOP) amounts for the year.
To see your up‑to‑date deductible and out‑of‑pocket amounts, visit blueprintportal.com. There, you can view your:
- Total deductible and how much you have met
- Out‑of‑pocket maximum and the remaining balance
- Recent claims and how each one affected your totals
Taking charge of your health
At every stage in life, health insurance provides the foundation to take control of your life, build healthy habits, and protect yourself from the unknown. Arkansas Blue Cross is here to help with comprehensive resources and customized support to assist in kickstarting your healthcare. Get the InsideTrack on the health basics of your health benefits.