Explanation of Benefits (EOB) FAQ

What is the explanation of benefits?

The explanation of benefits (EOB) explains the costs for services you received. This includes what the provider billed for, what Highmark paid for, and what you will need to pay. This document is an advanced notice about bills you might receive from a provider or providers. When you get a bill, you can compare it to the EOB to make sure everything looks correct.

Explanation of benefits  

Members get an EOB after we process certain types of claims. An EOB might include:

  • Patient information
  • Member ID number
  • Claims information
  • What you owe the provider
  • Information about your coinsurance, copay and your deductible
What is the amount not covered on the EOB?

The amount not covered by your health plan.  

What is the total cost on the explanation of benefits?

The amount you’ll pay for the service or procedure.

What does the price without the insurance mean on the EOB?

This is the total price for the service or procedure before insurance is applied. It’s the amount you would be billed if you didn’t have insurance.  

What does the price with the insurance mean on the EOB?

This is the price for the service after your insurance was applied. We negotiate prices for you, to keep costs down.  

What is a copay?

Your out-of-pocket cost for a visit to a provider.  

What is a deductible?

The amount you pay before your insurance company starts to pay for covered expenses.  

What is coinsurance?

Your share of the costs of a health care service. You and your insurance company each pay for a percentage of the health care costs.  

What is the "total responsiblity"?

The provider will bill you for this amount.  

How do you view your explanation of benefits online?

Log in to your member account to view your EOB. If you're having trouble logging in to your member account, we can help. 

How to switch to an electronic explanation of benefits?

Log in to your member account to choose to have your EOB emailed to you.