Understanding your EOB

On the first page of your EOB under your name and address, you'll see a section called "Explanation of benefits." This section is a summary that shows the total amounts related to the claim or claims processed during the date range. If you have dependents, then these amounts include their claims as well.

Amount billed – This is the health care provider's price for the care you received, without taking your health plan into account.

Your discounted rate – Because you're an Asuris member, in-network providers have agreed to accept a discounted rate for the care they provide. This is sometimes called the "allowed amount" or the "negotiated rate"; it's the amount that your provider has agreed to actually charge for the care you received. Your benefits are applied to this amount.

Amount we paid – This is the amount that Asuris paid the health care provider based on your benefits. In certain situations, such as with self-funded plans, your employer may pay this amount.

Amount you owe – This is your share of the cost. This amount depends on if you've met your deductible as well your copay and coinsurance (more on this later). Keep in mind that you may have already paid your health care provider some or all of this amount at your visit—and this may not be reflected on your EOB.

Next on your statement, you'll find a couple of bar graphs showing your benefits status so far this year. We call these your benefit accumulators.

One graph shows your progress toward meeting your annual medical deductible. Your deductible is the amount you pay toward your health care costs each year before Asuris starts sharing the costs. (Some services, such as preventive care, are covered before you meet your deductible.)

Another graph shows your progress toward meeting your out-of-pocket maximum. Your out-of-pocket maximum is the most you'll have to pay for your covered health care each year before Asuris begins to pay 100% of your costs for the rest of the year.

There are also other benefit accumulators you can view online. To get the most up-to-date status, sign in and check out your benefits.

This section shows you a breakdown of the cost of each health care service that you received. The "Care details" section includes the same information as the summary on the first page—except for each individual service or claim.

There are a few additional columns with amounts that only appear in this detailed section:

Amount not covered – This is the difference between the health care provider's price and your discounted rate. In other words, it's the amount you saved by being an Asuris member.

Applied to your deductible – This is the amount that has been paid toward meeting your deductible.

Your copay/coinsurance – Your copay—a set amount you pay your health care provider for an office visit—is included in this amount (if your health plan has copays). It also includes coinsurance, which means cost-sharing. In other words, Asuris shares the cost of care with you, and this is your portion.

Listed beneath some services, you may also see a code that gives the reason why payment for some or all of the service was approved or denied. If you have questions about these reason codes, reach out to Customer Service.

One more thing to note: If you have more than one type of health plan, coordination of benefits applies—meaning, we'll work to make sure you receive the full benefit of your plans. In this case, your claims through other plans won't be on your EOB, but the costs will be reflected in your amounts.