“Why Am I Receiving These Things?”

Posted on June 22, 2011

HNE Member Services get calls frequently about why members keep getting HNE Explanation of Benefits (EOBs). When you have a plan with a deductible, HNE sends an EOB for claims when the deductible or coinsurance has been applied. Coinsurance is when HNE pays a percentage of the claim and you pay a percentage. Deductible is a dollar amount you pay out of pocket prior to HNE paying for an expense covered service.

Remember, the EOB is not a bill. It is an advice statement to tell you that HNE received a claim for a service provided to you. The billed amount is the total amount of the claim that HNE received. The EOB shows the provider name, date of service, type of service, amount paid by HNE, amount of copay, and the amount applied to the deductible.

EOBs also show you how much of your deductible you have met for that year. You also get correspondence similar to an EOB from HNE when we deny a claim. Denial letters tell you why we denied the claim and how to appeal a denial. If you have a deductible plan, HNE will not send an EOB for claims that did not have any deductible or coinsurance.

If you have a plan with no deductible, and only copayments, you will not receive any EOBs. Your copayments are listed on your HNE ID cards.

Most HNE members have access to our secure website, HNEDirect through our website, hne.com.

On HNEDirect, you can:

• View your Member Material and Benefit Information
• Change your Address and other Personal Information
• Change Primary Care Physicians
• View your Claims and Referrals

And lots more! Signing up for HNEDirect is easy:

1. Go to hne.com
2. Click HNEDirect
3. Follow the simple instructions

Once you sign up for HNEDirect, you can go green by asking us to stop sending paper EOBs. You will need “Level 2” security access to do so. Once you get Level 2 Security, you can start getting your EOBs electronically.

Why not sign up today!

Categories: Summer 2011