An Explanation of Your Explanation of Benefits (EOB)

What is a health insurance Explanation of Benefits (EOB)?

An Explanation of Benefits (EOB) Statement is a notification provided to members when a health care benefits claim is processed by Blue Cross and Blue Shield of Texas (BCBSTX). The EOB displays the expenses submitted by the provider and shows how the claim was processed. In most cases, an EOB will be mailed to you after a claim has been finalized. If you signed up for paperless statements, you will get an email notice when your EOB is ready for viewing through your Blue Access for MembersSM (BAM) account .

EOBYour EOB statement is an important record of claims for medical services and benefit coverage. The first thing you should do is carefully check your EOB. You want to be sure that the services you received match the services you were billed for. If something looks wrong, call us using the number on the back of your Member ID card or call your doctor to ask about it. Then, keep your EOBs for future reference -- just in case questions come up later about your claim or your bill. (Bonus if you’ve registered for BAM! We store your EOBs there for 18 months.)

The EOB has four sections:

  • Claim Information includes the member and patient name, the member’s group and ID numbers, and the claim number. If you want to learn more on how to read your claim, click on the Health Care School widget located in BAM  and watch the “Reading your Claim Statement” video.
  • Summary highlights the financial information – the amount billed, total benefits approved and the amount you may owe the provider.
  • Service Information identifies the health care facility or physician, dates of service and charges.
  • Coverage Information shows what was paid to whom, what discounts and deductions apply, and what part of the total expense was not covered.

The EOB may include additional information:

  • Amounts Not Covered will show provider discounts, or what benefit limitations or exclusions apply.
  • Out-of-Pocket Expenses will show an amount when a claim applies toward your deductible or counts toward your out-of-pocket expenses.
  • Appeals explains your rights regarding review of claim denials.
  • Fraud Hotline is a toll-free number to call if you think you are being charged for services you did not receive or if you suspect any fraudulent activity.

Below is a sample EOB that labels all the sections. Keep in mind, every plan is different and the charges on your EOB are according to your plan’s coverage and the services you received.


If you want to learn more about EOBs, go to the Health Care School section of BAM or check out any of these great Help Desk videos!

We know it gets a little tricky, so if you have questions about this explanation of your Explanation of Benefits, let us know in the comments!


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