Blue Cross Blue Shield of WNY
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  • Your Explanation of Benefits (EOB) outlines the costs for services you receive.
  • An EOB is not a bill. You do not need to respond to this document. It is for your records only.
  • Sign up to go paperless and we will notify you by email when your new EOB is ready.

Your EOB explained.

 

EOB-image_WNY

 

 

1. This is a summary of your visit, including the claim number.

 

2. This is the amount that your doctor billed—what the price would be without insurance.

 

3. This is the price BlueCross BlueShield of Western New York has negotiated for you—the price with insurance.

 

4. This is the amount of that bill that BlueCross BlueShield of Western New York paid.

 

5. Copay: An amount you may be required to pay as your share of the cost for a medical service or supplies, or prescription drugs. A copay is usually a set amount, rather than a percentage.

 

6. Deductible : The amount you must pay for health care or prescriptions before your insurance begins to pay.

 

7. Coinsurance: An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage.

 

8. This is the amount you are responsible for. You have either already received a bill from your doctor or medical facility for this amount, or will receive a bill.

Please note:

 

  • There may currently be charges on your account that you are responsible for—things like copays, deductibles, coinsurance, or services not covered or excluded. If so, you have either already received a bill from your doctor or medical facility for this amount, or will receive a bill. Please refer to your most recent bill for any amounts currently owed.

  • You may also get an Explanation of Payment, a document outlining claims you are being reimbursed for.

  • The example provided above applies to non-Medicare member only. EOBs for Medicare members may look different.

  • If you have further questions about your EOB document and want clarification, contact us to speak to a customer service representative. If you have questions regarding the status of your bill, contact your doctor's office of facility.