How to Read Your EOB
(Explanation of Benefits)
How to Read Your Claim Summary
This sample statement will show you where to look for information when your claims are processed. You will receive a Claim Summary that includes all family members during the noted period. You can see your weekly claims activity on our website by logging into your benefits portal website account at pbaclaims.com.
1. PBA contact information appears here. If you have any questions regarding your Claim Summary, please have your user ID number and claim number available when you call.
2. Your name and address will appear here.
3. Your group number, group name, and check generation date will appear here.
4. For the Period: Shows the period that claims were incurred.
5. Date(s) of Service: The date the services were incurred.
6. Type of Service: The type of service performed by your provider (office visit, lab, x-ray, etc.).
7. Total Charge: The total amount charged by the provider.
8. Ineligible Amount: Any amount not covered by the plan. Ineligible Amount will be further explained with a reason code description in section 18 and may be included in the amount you may owe.
9. Reason Code: Reflects any comments about why a service may not have been covered or any other important information.
10. Discount Amount: The savings amount applied to this claim will be reflected here. The patient is not responsible for this amount.
11. Covered by Plan: The new allowed amount of the claim after the ineligible and discount amounts are applied.
12. Deductible Amount: This reflects how much of the claim will be applied to your deductible.
13. Co-Pay Amount: This reflects the amount you will be responsible for as defined by your plan.
14. Balance Amount: The amount after all deductions (ineligible, discount, deductible, and co-pay amounts) are applied.
15. Paid At: The percentage of benefit paid by the plan.
16. Payment Amount: Reflects the total benefit that was paid by the plan.
17. Patient’s Responsibility: Any amount you may be responsible for will appear here (deductible, coinsurance, copayments, or services that are not covered).
18. Reason Code Description: Reflects any comments about why a service may not have been covered or any other important information.
19. Payment Details: Reflects who received a benefit payment for this claim.
20. Plan Status: Reflects your deductible and out-of-pocket amounts remaining as defined by your plan.
21. You Should Know: Special reminders and announcements appear here.