BlueCross BlueShield of South Carolina

Less is More

June 29, 2011

In the coming weeks, we will begin using a Summary Explanation of Benefits (Summary EOB). A Summary EOB combines all claim activity for each member covered under one ID on one document. For example, in the past, if a member and his or her dependent child each visited a doctor in the same month, we would send an individual EOB for each. Now, all information will be listed on the same Summary EOB.

We will move group members to Summary EOBs in two phases. The first phase will begin July 26 and the second phase will begin August 2. We will move individual under 65 members to Summary EOBs August 9.

We will create Summary EOBs every 21 days. Summary EOBs are for health care claims only; dental claims are not included. This information is included on the Summary EOB:

• What we paid providers
• What providers may bill
• Medicare or other insurance payments (if applicable)
• Individual and/or family totals for deductibles and out-of-pocket maximums
• Helpful definitions and appeal information
• Claims details showing information about each claim, such as charges, allowed amounts, coinsurance, deductibles, out-of-pocket amounts and payments

We will send an individual EOB only if a payment was made to the member. If a member needs a copy of his or her individual EOB, he or she may request a copy from Customer Service or download one from My Health Toolkit^®.

We have attached a list of frequently asked questions regarding Summary EOBs. Additionally, you can download brochures explaining Summary EOBs and individual EOBs on Storefront.

Please contact your marketing representative with any additional questions.

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