How Your EOB is Calculated

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

This is the total amount the provider billed TeamCare.

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 may not have to pay. Learn more about the benefits of using in-network providers.

Other Insurance (COB) Payments & Adjustments

If you have more than one source of health coverage, Coordination of Benefits (COB), this is the amount your other coverage is responsible for. 

Previous Payments & Adjustments

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

Plan Payment

This is the amount TeamCare is paying for your services.

Paid To

This is the person TeamCare is paying for your services.

Amount You May Owe

If you went to an in-network provider and 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. If you went to an out-of-network provider, this amount also reflects provider charges that were not covered by TeamCare.

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.

Plan Benefit Limit

For certain retiree plans, there is a Plan Benefit Limit, in which the member reaches the maximum amount of coverage they can receive for the year.

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.