NC Healthcare Coverage Blog

Since January 1, 2009, Blue Cross and Blue Shield (BCBSNC) has altered the arrangement of its Explanation of Benefits (EOB) for Blue Medicare Supplement products, to reveal what the provider charged and what Medicare allows. This information is found in the column, “Amount Provider May Bill You”.  In the past, even though this amount was a precise statement of the difference between the two charges, many beneficiaries were perplexed about the correct amount that they were responsible for. Because of this confusion, BCBSNC has redesigned the EOB presentation for Blue Medicare Supplement Products in order to make it easier for members to understand what they actually owe.

Last year, there was perhaps too much detail about the amount that was not owed by the members on the EOB in the section of the EOB titled “Paid by Medicare or applied to deductible.

The contractual difference between what the provider charged and what Medicare allows is shown this year in the ‘Explanation of Amount Provider May Bill You’ section. Any amount that the member is responsible for under their current plan is also shown. Now, to make things clearer for the member, the ‘Explanation of Amount May Bill You’ section now states, “This amount represents remaining expenses after Medicare and BCBSNC Plan determination.”

So what do members need to do? Well, the member should compare their EOB with our EOB to see how much they are financially liable for. They can do this by looking at their EOB that is sent to them once every quarter from Medicare.