How Your EOB is Calculated

After your claim is processed, you’ll receive an Explanation of Benefits (EOB) that details what was paid and, if a claim was denied, the reason why. An EOB is not a bill! It’s a good idea to review your EOB carefully and compare it to the statement from your provider.

Member and Subscriber Information

EOB section member subscriber info

Have this information on hand if you need to contact TeamCare with additional questions.

Summary of Charges and Payments

An easy way to understand your summary of changes and payments is to think about it like a math equation:

Total amount billed

PPO Discount/Non-billable

Other insurance payments

Previous Payments

– Plan Payment

= Amount you may owe

Total Amount Billed

EOB section total amount billed

This is the total amount the provider billed TeamCare.

PPO Discount/Non-Billable

EOB section PPO discount non-billable

Thanks to your TeamCare benefits, going to an in-network provider means you get discounted rates – this section shows the amount of your discount.

Even if you went out of network, this section still shows the amount of your bill you won’t have to pay. Click here to learn more about the benefits you get using in-network providers.

Other Insurance (COB) Payments & Adjustments

EOB section other insurance

If you have Coordination of Benefits (COB), this is the amount your other insurance is responsible for.

Previous Payments & Adjustments

EOB section previous payments

If your claim was reprocessed, this field will show the amount already/initially paid by your plan.

Plan Payment

EOB section plan payment

This is the amount TeamCare is paying for your services.

Paid To

EOB section paid to

This is the amount TeamCare is paying for your services.

Amount You May Owe

EOB section amount you may owe

If you haven’t paid your co-pay, co-insurance, or deductible yet, this field will show the amount you owe. You may have already paid this during your office visit.

Deductible, Out-of-Pocket Limit & Plan Limits Used by Patient

EOB section deductible, out-of-pocket

Deductible

This is the amount you’ll pay each year for services before your plan begins to pay.

Out-of-Pocket Limit

The out-of-pocket limit shows the most you’ll have to pay for services each year.

Appeal Procedures

If you don’t agree with the way your claim was processed or the payment amounts shown above, follow these instructions to appeal your claim.

Reverse Side

EOB

This page shows line-item details and a breakdown of the individual services you received.

Procedure Description

EOB section procedure description

This shows the billing category that describes the services your provider completed. Information on how much was billed for the services, how much was paid, and the amount you may owe appear in the following columns.

You can find out more about how these services are paid in your Plan Benefit Profile. Register on MyTeamCare.org to view your Plan Benefit Profile anytime 24/7.

Remarks

EOB section remarks

Additional messages about your claim may appear here, corresponding to the remarks column above. These remarks may include information on claim adjustments, Coordination of Benefits, the reason why TeamCare paid for a claim, or why TeamCare may have denied a claim. You can find additional information about the remarks in your Plan Benefit Profile, or on your MyTeamCare account dashboard.

If you don’t see any remarks, don’t worry – that means your claim is straightforward, and didn’t require any additional explanation.