An explanation of benefits (EOB) is a statement from your health plan that shows what it covered for care you received and how much you may be responsible for paying out of your pocket. The EOB lets you know that your claim has been processed, but it’s not a bill. Your provider will send you a bill for any balance you owe, which should match the amount the EOB shows as being your responsibility. Be sure to promptly review all EOBs you receive to make sure they are correct.
As claims administrator for the Medical Plan, Highmark Blue Cross Blue Shield (BCBS) processes medical claims and sends EOBs to members and their covered families, while Express Scripts is the administrator for prescription drug benefits.* If you are enrolled in the PPO, EPO, or HDHP option, you can access both medical EOBs and prescription drug claims information using the MyQHealth website and mobile app.**
You can access EOBs for covered children under age 18 by choosing their name from the drop-down menu under Member in the My Claims Details section. Covered spouses and children ages 18 and older will need to register for the MyQHealth website and create their own profile. Once logged on, they can give you access to their claims information by going to Profile Settings > Privacy Authorization and checking the box to grant you access.Watch your mailbox! If you’re enrolled in the PPO, EPO, or HDHP, you should receive your Prescription Benefits Review, summarizing your prescription drug claims and costs for 2021, from Express Scripts in the next few weeks.
You can also use the MyQHealth website and mobile app to view prescription drug claims processed by Express Scripts. This section does not include any EOBs generated by Express Scripts, but you can view a list of your prescriptions for 2022 and the dates they were filled by selecting the MEMBER RX DETAIL tab under My Claims Details. For more information, including how much the plan covered, click the + symbol to the right of the fill date.
If you need help understanding an EOB, or believe your claim was processed incorrectly, contact Quantum Health. As part of care navigation,** Quantum Health’s Care Coordinators are well versed in the medical benefits provided through the Board of Pensions and can answer your questions. As your personal healthcare guide and advocate within the healthcare system, your Care Coordinator will work directly with your provider and Highmark BCBS to resolve any issues.
Your Care Coordinator can also help if you have a question about a medical or prescription drug claim from 2021. (Claims prior to January 1, 2022, cannot be accessed through the MyQHealth website or mobile app.)
*Claims and EOBs for members enrolled in Triple-S or GeoBlue are processed by their plans.
**Care navigation and MyQHealth are available to employees and their family members enrolled in the PPO, EPO, or HDHP medical options; it is not available to members enrolled in Triple-S, GeoBlue, or the Medicare Supplement Plan.