An Explanation of Benefits (EOB) is not a bill: it shows what your provider charged, what your plan allowed and paid, and what you may owe. If a claim or prior authorization is denied, you have the right to an internal appeal with the plan and then an independent external review.
Claims & Appeals
When a claim or prior authorization is denied, members have the right to appeal. These FAQs explain Explanations of Benefits (EOBs), coordination of benefits, and the internal and external appeal process.
What is coordination of benefits when I have two health plans?
When you’re covered by two health plans, coordination-of-benefits (COB) rules decide which pays first (primary) and which pays second (secondary). The secondary plan doesn’t simply double your coverage; together the plans generally pay up to, not beyond, the allowed amount for a service.