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. You can also view digital copies in your member account under the Costs & Spending tab at the top of the page.

Personal information and claim summary

how to read your Explanation of Benefits key
  1. Your name and ID (contract number on your membership card) and our customer service phone number. 
  2. 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.
  3. Bill amount. Total amount your provider billed Priority Health for the services listed (without the discount).
  4. Discount. Amount discounted from the bill amount because you have a health plan with us.
  5. Priority Health paid. Total amount Priority Health has paid toward the amount your provider billed.
  6. Other insurance paid. If you have other coverage, this is the total amount other insurance paid toward what your provider billed.
  7. 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.

Claim details

How to read your EOB claim details screenshot
  1. Your share. A breakdown of your share of the provider’s bill.
  2. Deductible: Amount you pay yearly before your health plan pays for services. See plan documents for details.
  3. Coinsurance: After your deductible is met, coinsurance is your portion of the cost for medical services or prescriptions listed as benefits in your plan.
  4. Copayment: Also known as copay. The portion paid at the time you receive health care service or prescription is filled.
  5. Other*: Additional services or procedures not covered under your plan, charged by your provider.

Deductible balances

deductible balances
  1. Met. How much of your total deductible has been met, including your share of the costs listed in this EOB.
  2. Total. What the total amounts of your contracted plan deductibles are.

Total - Met = The remaining amount you need to meet each deductible

Questions?

In your member account, select Get Help to send us a secure message. Or you can call the Customer Service phone number on the back of your member ID card.

*If you have a Telehealth PCP - Virtual First plan you must first contact your assigned virtual Doctor On Demand primary care physician (PCP) to receive non-emergency care. Please refer to your plan documents for more information.