Part C Explanation of Benefits (EOB)
An Explanation of Benefits is a notice that includes the details and payments made for services you received. You can sign up to receive electronic Explanation of Benefits by logging in to MyPeoplesHealth, a member portal just for you, then clicking the Electronic Preferences tab.
Frequently Asked Questions
What is an EOB?
An EOB is a notice that includes the details and the payments made for services you received. It tells you what the plan pays and what you pay for each service. It also includes information about what to do if we deny payment for a service.
Do I need to do anything with my EOB?
You should review your EOB to help you understand your health care costs. It has information about services you received, and it lists your share of the cost for the service and the amount that Peoples Health paid for the service.
Remember, your EOB is not a bill. A provider might send you a bill separately. If you get a bill, contact us. We can help you find out what you owe, if anything.
Is an EOB a bill?
No. We send you an EOB to help you understand your health care costs. There are times when a provider may send you a bill separately. If you get a bill and have questions, contact us. We can help you figure out what you owe, if anything.
My EOB lists a denied service. Will my provider bill me for the denied costs?
It depends. The most important thing to remember is that as long as you get covered services from a provider in our provider network, you only pay your plan copay or coinsurance. You are not responsible for paying any more than that amount. However, if your plan does not have an out-of-network benefit and you received a service from a provider who is not in our provider network and we did not authorize the service in advance, you may have to pay the entire cost of the service.
In either event, if you get a bill from a provider and have questions, contact us before you make any payment. We can discuss the bill with you and help you determine what you owe, if anything.
I received the services listed on my EOB a long time ago. Why am I only getting this information now?
Health care providers have 365 days from the day you receive the service to send us a claim for the service. We also must follow special guidelines when processing a claim. Either one of these reasons could have caused the service to appear on your EOB long after you received the service.
There are services listed on my EOB that I did not receive. What do I do?
If you think you did not receive a service listed on your EOB, ask your provider to explain the service or contact us so we can help you.
I am no longer a Peoples Health plan member. Why did you send me an EOB?
Medicare requires us to send an EOB whenever we pay a provider for health care services. Providers have 365 days to send us a claim, and we must follow special guidelines when processing it. Even though you are no longer a Peoples Health member, you received the services you see on your EOB while you were a member of our plan.
If we paid for a service you received after you disenrolled from your Peoples Health plan, contact us so we can help you.
Why does Peoples Health send an EOB to someone who is deceased?
Medicare requires us to send an EOB whenever we pay a provider for health care services. Providers have 365 days to send us a claim, and we must follow special guidelines when processing it. This means an EOB may be sent after a member has passed away.
I do not want to receive EOBs anymore. Can I opt out of receiving them?
Medicare requires us to send EOBs. At this time, you are not able to opt out of receiving them.
Can I get my EOBs online?
Yes. You can sign up to receive EOBs electronically through MyPeoplesHealth, a member portal just for you. If you haven’t already, you will first need to create a MyPeoplesHealth account. All you need is your name, your date of birth, and your member ID number, which is printed on your plan ID card. Once you are logged in, click the Electronic Preferences tab.
If I sign up to receive EOBs electronically, will I still get a paper EOB in the mail?
No. If you sign up to receive EOBs electronically, you will no longer get EOBs in the mail.