Applicable for commercial group, individual and Medicaid members.
What’s an Explanation of Benefits (EOB)?
A record of the medical services you received over a certain amount of time. A detail of items that your provider billed Priority Health, what was paid and your expected share of
the cost. Your provider will bill you your share.
When will I receive an EOB?
Whenever you receive a medical service and a provider bills us for that service, we’ll send you an EOB unless your share is $0 or only your copayment amount. This is the claims process. Log into your member account to see current and past claims online.
What should I do with my EOB?
Keep a record of your EOBs and file all of your paper copies. We recommend going paperless to receive an email when a new claim statement is available in your member
account. To do this:
- Log in
- Select My Plan, Claims, then Claim Detail
- Click Manage Paperless Settings to select your paperless preferences
Personal information and claim summary
- Your name and ID (contract number on your membership card) and our customer service phone number.
- The date Priority Health paid for the medical services listed on the EOB. Your claim number is used as a tracking number and a reference number if you call customer service.
- Bill amount. Total amount your provider billed Priority Health for the services listed (without the discount).
- Discount. Amount discounted from the bill amount because you have a health plan with us.
- Priority Health paid. Total amount Priority Health has paid toward the amount your provider billed.
- Other insurance paid. If you have other coverage, this is the total amount other insurance paid toward what your provider billed.
- Your share. If your deductible hasn’t been met, or a copay or coinsurance applies, this amount is your expected share of the cost. You can expect this bill from your provider.
- Your share. A breakdown of your share of the provider’s bill.
- Deductible: Amount you pay yearly before your health plan pays for services. See plan documents for details.
- Coinsurance: After your deductible is met, coinsurance is your portion of the cost for medical services or prescriptions listed as benefits in your plan.
- Copayment: Also known as copay. The portion paid at the time you receive health care service or prescription is filled.
- Other*: Additional services or procedures not covered under your plan, charged by your provider.
- Met. How much of your total deductible has been met, including your share of the costs listed in this EOB.
- Total. What the total amounts of your contracted plan deductibles are.
Total - Met = The remaining amount you need to meet each deductible
Send us a message in your member account or call the Customer Service number on the back of your member ID card.