Once you visit your doctor, and have a claim with Blue KC, you’ll receive an Explanation of Benefits (EOB). We send this statement after we process your claim. Your EOB contains a variety of important terms and information including how much money you’re responsible for paying on the claim.
- Member Information Section: Information about you and your recent claim.
- This is Not A Bill: Your EOB is not a bill. It’s an accounting of how we processed your claim. You may receive a bill from your provider. You can use your EOB to ensure the amount your provider billed you is correct based upon your coverage with Blue KC.
- Narrative: Provides you with a brief overview of how your claim was processed.
- Claim-At-A-Glance: A math equation to show how your claim is paid.
- Detailed Explanation of this Claim: This area combines critical payment information into one convenient summary. Please review this carefully as it clearly outlines your Blue KC negotiated savings as well as any fees and services you’re responsible for.
- Blue KC Member Savings: Blue KC has negotiated this savings with providers on your behalf. Without these savings, your personal liability to your provider would be much higher. This is one of the most valuable aspects of having Blue KC coverage.
- Other: This area represents amounts that are deducted from the Billed Charges for different reasons.
- Allowable Charges: This is the amount of the claim after all discounts and other reductions. Deductible and coinsurance amounts are calculated from this figure.
- Copay: If your plan has copayments, this section represents the dollar amount of a charge you must pay each time a certain covered service is received.
- Deductible: This dollar amount represents what portion of the claim is being applied to your plan deductible, if applicable. The deductible is the amount that must be incurred by each member before benefits become payable by Blue KC.
- Coinsurance: The percentage of an allowable charge you must pay for a covered service. Generally, your deductible must be met before your coinsurance applies.
- Plan Payment: This is the amount that Blue KC will pay to the provider (or member, if member-submitted) for the claim.
- Deductible Information: This area documents what your deductible status was at the time the claim was processed. Many times this information will be outdated by the time you receive an EOB. You can get your most recent and up-to-date deductible information in the Plan Usage section of MyBlueKC.com.
There are different ways to receive an EOB.
Want to opt-out of receiving paper copies? Only want to receive an EOB when a payment is due? Simply visit Manage Communications and specify your communication preferences. No matter how you choose to receive your EOB, know that they’re always available in the Claims section of your File Cabinet.