Confused by EOBs?

Learn how to understand each part of your statement.

Illustration of the concept of having questions about Explanations of Benefits (EOBs)

After you visit a doctor, dentist or other medical professional, you'll get an EOB in the mail. (Or, go green and sign up for paperless options.)

It looks similar to a medical bill, but it's not a bill—it's a statement from Regence with detailed information that can remind you of the services you received and help you track your health care expenses. It also shows you the value of your health care benefits.

EOBs can be difficult to understand. We'll start with what an EOB is, and then go through each part of a Regence EOB. To follow along with your own EOB, open a new tab in your browser and sign in to view your EOBs online. You can also easily pull up your EOBs using the Regence app.

In general, an EOB includes:

Explanation of benefits details icon (conceptual)

Details about the claims submitted to Regence

Explanation of benefits coverage amount icon (conceptual)

How much Regence covered

Explanation of benefits how much you owe icon (conceptual)

How much you owe to your provider

Let's take a closer look

There are three main sections of your EOB.

Section 1: Explanation of benefits summary

On the first page of your EOB under your name and address, you'll see a section called "Explanation of benefits." This section is a summary that shows the total amounts related to the claim or claims processed during the date range. If you have dependents, then these amounts include their claims as well.

Amount billed – This is the health care provider's price for the care you received, without taking your health plan into account.

Your discounted rate – Because you're a Regence member, in-network providers have agreed to accept a discounted rate for the care they provide. This is sometimes called the "allowed amount" or the "negotiated rate"; it's the amount that your provider has agreed to actually charge for the care you received. Your benefits are applied to this amount.

Amount we paid – This is the amount that Regence paid the health care provider based on your benefits. In certain situations, such as with self-funded plans, your employer may pay this amount.

Amount you owe – This is your share of the cost. This amount depends on if you've met your deductible as well your copay and coinsurance (more on this later). Keep in mind that you may have already paid your health care provider some or all of this amount at your visit—and this may not be reflected on your EOB.

Inset closeup of an image of the first section of an EOB
Section 2: Your benefits status

Next on your statement, you'll find a couple of bar graphs showing your benefits status so far this year. We call these your benefit accumulators.

One graph shows your progress toward meeting your annual medical deductible. Your deductible is the amount you pay toward your health care costs each year before Regence starts sharing the costs. (Some services, such as preventive care, are covered before you meet your deductible.)

Another graph shows your progress toward meeting your out-of-pocket maximum. Your out-of-pocket maximum is the most you'll have to pay for your covered health care each year before Regence begins to pay 100% of your costs for the rest of the year.

There are also other benefit accumulators you can view online. To get the most up-to-date status, sign in and check out your benefits.

Inset closeup of an image of the benefit accumulator bar graphs in an EOB
Section 3: Care details

This section shows you a breakdown of the cost of each health care service that you received. The "Care details" section includes the same information as the summary on the first page—except for each individual service or claim.

There are a few additional columns with amounts that only appear in this detailed section:

Amount not covered – This is the difference between the health care provider's price and your discounted rate. In other words, it's the amount you saved by being a Regence member.

Applied to your deductible – This is the amount that has been paid toward meeting your deductible.

Your copay/coinsurance – Your copay—a set amount you pay your health care provider for an office visit—is included in this amount (if your health plan has copays). It also includes coinsurance, which means cost-sharing. In other words, Regence shares the cost of care with you, and this is your portion.

Listed beneath some services, you may also see a code that gives the reason why payment for some or all of the service was approved or denied. If you have questions about these reason codes, reach out to Customer Service.

One more thing to note: If you have more than one type of health plan, coordination of benefits applies—meaning, we'll work to make sure you receive the full benefit of your plans. In this case, your claims through other plans won't be on your EOB, but the costs will be reflected in your amounts.

Inset closeup of an image of the care details section of an EOB focused on deductible and copay/coinsurance

We're here to help

EOBs can be complicated, and it can be tempting to ignore them since they're not medical bills. But EOBs have useful information that can help you make sure you actually received the services listed, check that the amounts your provider received and your share are correct, and see how much you owe your provider for a service. This way, you can feel confident that any bill your get from your provider accurately reflects what you owe.

 

Still have questions?

Contact Customer Service or sign in to view your EOBs.