Highmark benefit eob sample 2025

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The document provides a detailed explanation of an Explanation of Benefits (EOB) statement, clarifying that it is not a bill but rather a summary of how health insurance benefits have been applied to a specific claim. It outlines key information such as the contract holder's details, claim activity, payment amounts, and patient benefit summaries for both individual and program coverage. Additionally, it includes definitions of important terms related to health insurance billing and encourages reviewing the EOB for accuracy.

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What are the 5 pieces of information found on an EOB?

If you have a doctors bill that cannot match one or more EOBs, it is likely that your insurance has not been applied to that bill. This can happen for a number of reasons. A common issue is that the doctor filed the claim to an outdated insurance policy or the name or birthdate did not match our records.

How do you interpret explanation of benefits?

The explanation of benefits lists the cost of your care, and how much your health insurance company will pay. Provider Charges is the amount your provider bills for your visit. Allowed Charges is the amount your provider will be paid. Paid by Insurer is the amount your health plan will pay to your provider.

What is the EOB explanation of benefits?

The EOB will show a variety of information, including details about the medical treatment, the amount that was billed, the amount that the health plan allows for that service, the amount the health plan paid (if any), and the amount that the patient owes.

How to read an EOB explanation of benefits?

EOBs are usually mailed once per month. Some plans give you the option of accessing your EOB online. Your EOB is a summary of the services and items you have received and how much you may owe for them.