Hot Tip #24: Don't Pay Your Provider until you Review Your EOB!

For each service you receive, there is an Anthem Explanation of Benefits (EOB) that outlines all of the financial details for that service! Understanding how to read an EOB will help you determine whether or not your provider is billing you the correct amount! You should NOT pay for a medical service, except for copays until you receive your EOB from Anthem. This ensures you don’t OVERPAY for any service covered by the plan.

VERY IMPORTANT

Some hospitals or facilities may ask you to pay upfront for services that do not have a copay before you receive the procedure

If you do this:

  • WAIT to pay the final invoice until you have received your EOB
  • Make sure the provider invoice matches what your EOB states that you owe AND;
  • Make sure the amount you paid upfront was deducted from the billed charges on the provider invoice
  • And is reflected on the EOB so that your deductible and/or out of pocket maximum is correct
Service provided for:
Jane Q Member (Self)
Claim Number
123456891234
Provider
Deaconess Hospital
Network Status
Out-of-network
Patient Account
98765432198765

1

Day you got care Services received

2

Reason code Amount charged by your provider Your discounts
-
Amount due to your provider
=

3

Another insurance paid
-
Anthem paid
-
Your health account paid
-

4

Copay
+
Deductible
+
Coinsurance
+
Services not covered
+
Total you pay (or may have paid)
=
1/8/15 Office visit 135 175.00 -77.00 98.00 0.00 -73.00 0.00 25.00 0.00 0.00 0.00 25.00
1/8/15 Lab Service 038 68.00 -50.50 17.50 0.00 0.00 0.00 0.00 17.50 0.00 0.00 17.50
1/8/15 Lab Service 038
067
55.00 -39.50 15.50 0.00 -6.40 0.00 0.00 7.50 1.60 0.00 9.10
Subtotal 298.00 -167.00 131.00 0.00 -79.40 0.00 25.00 25.00 1.60 0.00 51.60
Section 1: Shows who received the service and the relationship to the cardholder
Section 2: Includes the day you received care, type of services and an explanation of payment codes
Section 3: Shows Charges: the amount billed by your providers and how much is owed
Section 4: Shows how much another insurance plan pays. This section only appears if Anthem is the secondary insurance carrier.
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