Understanding your Explanation of Benefits

What is an Explanation of Benefits?

An Explanation of Benefits (EOB) gives you details about health care services you recently received. It is not a bill, but it will tell you whether you are responsible for a copay, deductible, coinsurance, or any other amount. It will also tell you if your claim was denied and the reason for the denial. You do not pay anything to anyone when you receive your EOB.

How does the process work?

1. After you receive care, your provider sends UPMC for Life a claim.
2. We process your claim based on your specific plan benefits.
3. We get back to your provider with how much we will pay and what you will owe your doctor (if anything).
4. We send you an EOB as claims are processed as well as on a quarterly basis. This summarizes how we processed your claims and what you may owe your providers. Your EOB is not a bill. You do not pay anything to anyone when you receive your EOB.
5. If you owe your provider money, the provider will send you a bill separately.

Understanding your EOB

We know the EOB can be confusing. See our quick guide (PDF) | tutorial de la explicación de beneficios (PDF) to learn about your EOB.

Where can I find my EOB?

You can access these documents anytime through the UPMC Health Plan member site or app.

Tip: Download your EOB to your mobile device or computer to save for your records.

View my EOBs

Don’t have an account yet? If you’re a first-time user, creating a UPMC Health Plan Login is fast, easy, and secure!

• Visit our New User Registration page or download the UPMC Health Plan app to your device.
• Follow the prompts to create your login.
• Keep your UPMC Health Plan Login safe and secure! After you create your login, you will use the same username and password to log in to the UPMC Health Plan member site, UPMC Health Plan app, and RxWell®.

Once you have an account, you can access these documents anytime through the UPMC Health Plan member site or app.

Go paperless by updating your preferences today!

Get your EOBs electronically through the UPMC Health Plan member site or app. We will email you a link so you can see your EOBs electronically. Changing your preferences will replace getting your EOBs in the mail.

Ready to go paperless? Learn more about how to go paperless.