1. Customer service info. If you have questions regarding your EOB, call 800.433.0088 for further assistance.
2. Payment made to the provider for this claim
3. Deductible applied this year for individual or family.
4. Group info.
- GRP: Name of Employer Group the member is enrolled under.
- Provider: Your Doctor's Name - this is the name of the provider that performed the services.
5. Claim #
6. Patient name
7. Patient Account # that the provider submitted on claim
8. Member name
9. Relationship of Patient to Member
10. BEST Life Member ID #
11. Date(s) of Service - the date the services were rendered by your provider.
12 High level description of the services rendered by your provider.
13. Member total responsibility.
- Total Charge: total amount being charged by your provider for services rendered, by type of service.
- Provider Discount: If a Preferred Provider was seen and a discount amount is applied. The amount of discount is not billable to the patient.
- Deductible/Copay: any amount applied to the member's deductible. This amount is billable to the patient.
- Pay %: This is the percentage of the Balance that is paid by the plan. The difference between the coinsurance amount and 100% is part of the patient liability.