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Explanation of Benefits

After you visit a PPO provider, you’ll receive an Explanation of Benefits (EOB) from Anthem Blue Cross. An EOB provides information about:

  • How your claim was paid.
  • The amount you’ll be reimbursed or may still owe.

Here are some terms and definitions to know when reviewing your EOB:

  • Service Date. The date(s) on which you received health care services.
  • Amount Charged. The amount billed by the provider who performed each service.
  • Allowable Charges. The price Anthem Blue Cross has approved for that service (includes any deductible, coinsurance or other amounts for which you are responsible).
  • Other Amounts Not Covered. A cost that exceeds your benefits or cost for services that aren’t covered. You may be responsible for this amount (plus any deductible, coinsurance or copayment).
  • Applied to Deductible. An amount that is considered part of your deductible (the amount you must pay for covered health care costs before your benefits are paid). You are responsible for this amount.
  • Copayment. The set amount that you pay for benefits. You are responsible for this amount.
  • Coinsurance. The amount remaining after the plan pays its share of covered services, usually shown as a percentage of negotiated charges. You are responsible for this amount.
  • Amount Paid. The total amount paid to you or your provider.