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What you need to know

Claims Overview
Medical Claims

When you receive a medical bill:

  1. Match the bill with your insurance explanation of benefits (EOB). Tip Find the correct EOB by matching date of service and total charged amounts (See below for online access to EOBs).
  2. Review for Balance Billing. Compare Patient Responsibility amounts listed on the bill and insurance EOB. If the bill states you owe more than the EOB lists as your responsibility amount = Balance Bill. This bill needs to be sent to your primary insurance for Balance Bill review. (See below for your specific insurance information)
  3. Gap Submission. If your plan includes gap coverage, make sure your medical providers/facilities have both your primary and gap insurance cards. Billing offices will submit claims to your primary insurance first. Once they have the primary's EOB, they should submit to gap.
  4. Submitting Gap on Your Own. Send the bill and EOB to your gap coverage carrier (See below for your specific coverage instructions). Sample Bill - Sample 1500 Form - EOB Samples EOB or EOB