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Health insurance basics

Understanding your Explanation of Benefits (EOB)

An Explanation of Benefits (EOB) is a notification form BlueAdvantage Administrators of Arkansas sends you after processing a claim. This form explains the total amount billed, the amount paid, and who was paid. It's a good idea to keep a copy of any bill you receive from a provider of medical services to compare to your EOB. You can also view your EOBs inside My Blueprint.

Sample EOB

Sample of an Explanation of Benefits.

EOB description

The following is a description of the items listed on the EOB. The field numbers referenced within the sample EOB correspond with the field names and descriptions provided below. Field 21 is probably the most important to you. It shows the total amount you, as the patient, are responsible for paying.

FIELD NUMBERFIELD NAMEFIELD DESCRIPTION
1Subscriber NameThe name of the contract holder who meets all applicable eligibility requirements.
2Patient NameThe name of the person who received the service. This could be you, your spouse, or a dependent child who has coverage under your health plan.
3RelationshipThis is the patient's relationship to the subscriber.
4ID NumberThe member number of the person receiving the service.
5Group NameEmployer name.
6Group NumberThe number assigned to your employer for tracking purposes.
7Claim NumberThe number assigned to this claim for tracking purposes.
8Provider of ServiceThe health-care professional or facility that provided services to the patient.
9Provider NumberThe number assigned to the provider.
10Date of ServiceThe date the patient received services.
11Type of ServiceA description of the type of service provided.
12Billed AmountThe amount the provider charged for the service.
13Allowed AmountThe customary amount for a service from which your coinsurance, if applicable, will be determined.
14Non-covered AmountThe amount, if any, for non-covered services or the amount that is above the allowed charge when seeing an out-of-network provider.
15Deductible AmountThe amount, if applicable, you pay to providers for services each benefit period before your health plan starts paying their share.
16Copayment AmountThe amount you pay to the provider each time you receive a certain service.
17Coinsurance AmountThe percentage of the Allowed Amount you pay to the provider for covered services for which the member is responsible. The Allowed Amount includes amounts withheld from provider payment, which are subject to the terms and conditions of the contractual agreement with the provider.
18Primary Payer AmountThe amount paid by another insurance carrier.
19Provider Adjustment AmountThe amount the provider must write off and/or the amount that has been withheld from the provider payment subject to the terms and conditions of the contractual agreement with the provider. The provider cannot bill you for this amount.
20Provider PaymentThe amount your health plan paid, based on your coverage and the contractual agreement with the provider.
21Your Minimum ResponsibilityThe amount you pay to the provider for this claim. This includes any copayment, coinsurance, deductible, non-covered services, and the amount above the allowable for the out-of-network providers.
22Deductible and/or Out-of-Pocket MaximumIf applicable, this area shows how much of this claim went toward your deductible and/or maximum out-of-pocket expenses and how much you have left before you meet your maximum.
23Explanation CodesThis is an explanation of activity that occurred on this claim/service and describes how the claim was processed.