Know How Your MVP Medicare Advantage Plan
Works for You
Your Explanation of Benefits (EOB) isn’t a bill. It helps you understand how your MVP Medicare Advantage plan is working and to help you plan for any bills your health care provider(s) may send you.
Here’s how your coverage works:
- After you see a health care provider, they send a claim to us
- We review the claim and determine how much of the claim your plan covers
- If we cover the care or service, we pay the covered amount and send you an EOB
- Your provider receives our payment (if we cover the care or service) and bills you for the outstanding
or allowed amount
You should keep your EOB for your records. Check your EOB against your provider’s bill before sending them any payments.
Visit our Health Glossary [link to Health Glossary, page ID 1.6.4.2] to find definitions of any unfamiliar terms related to your EOB. Call our Medicare Customer Care Center 1-800-665-7924 (TYY 711) if you have questions about your EOB.
Your Claim Summary
The first page of your EOB includes a claim summary. This includes four key areas:
- Billed Charges: This is the amount your provider billed us. It doesn’t include any discounts we’ve negotiated
to save you money. - Not Covered/Due from Patient: This amount is for any billed charges that your
MVP Medicare Advantage plan doesn’t cover. We include this amount in the What You Owe total. - Paid by Plan: This is the amount we’ll pay your provider if we cover the care or service.
- What You Owe: This is the amount you may owe your provider. It may not include any co-pays you
have already paid them. This amount should match the amount on the bill your provider sends you.
Your Claim Details
The second page of your EOB includes an itemized list of individual charges from your provider and what your MVP Medicare Advantage plan covered:
- Allowed Amount: We save you money with our negotiated rates with in-network doctors, hospitals, and facilities.
- Not Allowed/Not Due from Patient: This is the amount you save due to our lower negotiated rates
with your provider. - Not Covered/Due from Patient: Check the Reason Code(s) at the end of the row, and then look at the end
of the Claim Details section for why we didn’t cover this charge. - Other Insurance Payments: This is any payment from another policy that covers you.
- Deductible/Co-insurance/Co-pay: The total of these three columns should equal the Amount You Owe
section on page one of your EOB. - Paid by Plan: This is the amount we paid your provider.
- Reason Code(s): Check this code with the same code at the end of your Claims Details section for
more on any charges your plan doesn’t cover.