Explanation how to read blue cross blue shield insurance card

How do I read my Blue Cross Blue Shield of Michigan explanation of benefits?

Who is this for?

Blue Cross Blue Shield of Michigan and Blue Care Network members.

When you get health care, the doctor, hospital or dentist asks us to pay for the service they provided by submitting a claim.

After we process the claim, you get an explanation of benefits, or EOB. It’s the statement that says This is Not a Bill.

If it’s not a bill, what is it?

What's in an EOB

EOBs show you the costs associated with the services you received, including:

• What was billed
• Any discounts
• What we pay
• Total covered
• What you pay

Since an EOB isn’t a bill, what you pay is for your information only.  If you owe the doctor, hospital or dentist, they’ll send you an invoice. Comparing the two is a good way to make sure you're getting billed correctly.

Not all claims generate an EOB. For example, you won’t get an EOB for a prescription. Here’s what you can expect to see in your medical and dental EOBs.

Read EOBs in your member account

Most members can see EOBs by logging in on our website or using the Blue Cross mobile app.

For subscribers

If you’re the person whose name is on your Blue Cross ID card, look for the Explanation of Benefits link in the menu under Claims.

If you’re not the subscriber

After you’re logged in, go to Claims. Select a claim to see its details. If an EOB is available, you’ll see it there.

How to stop paper EOBs

Subscribers—the person whose name is on your Blue Cross ID card—can tell us to stop sending a paper copy of EOBs in the mail. Then we email when a new EOB is ready to view. To stop or start paper statements:

• Log in to your member account on our website or mobile app
• Go to Account Settings on our website, My Account on the app
• Choose Paperless Options

You can change your settings whenever you want.

Questions members ask about EOBs

"Why don’t you tell me which person or plan an EOB belongs to when you email that it’s ready to view?"

EOBs are considered protected health information. Because email isn’t secure, we can’t provide any details that might identify who the EOB is for.

"Why do you take so long to post or send my EOB?"

Statements go out on a four-week schedule. You can get information about a claim before your EOB is ready in your member account. Just go to the Claims section.

You present your insurance card when you go to the doctor's office or visit a pharmacy. You know it's important and you need to have it, but why?

As part of the federal Consolidated Appropriations Act of 2021 (also known as the No Surprises Act), updates have been made to your member ID to help you better understand your plan’s deductibles and out-of-pocket maximums. 

All members will receive a new member ID card in 2022. Please dispose of your old card properly to protect your member information and keep your new card in a safe and secure place. 

How to Read Your Member ID Card

Note: This is a sample ID card. Cards may vary from member to member.

1. Your Member ID Number

Your Blue Cross ID card has your identification number (also known as your member ID number in some applications) and group number. You’ll need this information when receiving medical services at the doctor or pharmacy, or when calling customer service for assistance.

Your member ID number is also important to have so that you can register for the Member Resource Center and access various member benefits including discounts and health and wellness services. When referencing your member ID number, you often times need the last 13 digits of your ID (exclude the first three letters) and the 2-digit number on the Member line (typically above your name on the card).

2. Your Plan Type

If you aren’t sure what type of health insurance plan you have, you can find out on the upper right corner of your ID card. The type of plan you have can affect what providers are in-network.

• Four products will show the PPO suitcase icon in the lower right corner: Open Access Plan, Exclusive Provider Organization (PCP), Exclusive Provider Organization, Vermont Freedom Plan (PPO). All other products will have an empty suitcase icon.

3. Your Costs 

Your co-pays are printed on the front right side of your card so that you know what to expect upon your next visit. Your ID card may also include your deductible and out-of-pocket maximum.

• A co-pay is a fixed amount you pay for a covered health care service.
• A deductible is the amount you pay for covered health care services before your insurance plan starts to pay.
• Coinsurance is the percentage of costs you pay after you’ve paid your deductible.
• The out-of-pocket maximum is the upper limit on the amount of money you will pay for healthcare services in a plan year.

4. Pharmacy Coverage

If you have pharmacy benefits through Blue Cross, the back of your ID card will have VERMONT BLUE Rx printed on the bottom.

• Your RX Group is used by your pharmacy to process your prescription benefit
• Your BIN or bank identification number tells your pharmacy that you are covered by Blue Cross and Blue Shield of Vermont.
• Your PCN or processor control number is used by your pharmacy to locate your pharmacy member profile.
• The Formulary code represents a list of prescription drugs covered by us. 

5. Contact Information

The back of your ID card provides important contact information for customer and provider service.

FAQ’s About Your member ID Card

Q: I just signed up for a plan, when will I receive my member ID Card?
A: You can expect your Member ID card to arrive within 7-10 business days from the date that you enrolled. 

Q: How often do I get a new member ID Card?
A: Members will receive a new ID card when a change is made that impacts the information on the ID card, or if one is requested.

Q: What do I do if I lose my member ID Card?
A: You can request a new ID card by using our secure Member Resource Center, emailing , or calling Customer Service at (800) 247-2583 Monday-Friday from 7:00 a.m. to 6:00 p.m.

Q: I have an appointment, but I don’t have my member ID Card, what do I do?
A: You can request a new card or confirm your ID information before your appointment by using our secure Member Resource Center, emailing , or calling Customer Service at (800) 247-2583 Monday-Friday from 7:00 a.m. to 6:00 p.m.

• Through the Member Resource Center, you can also access a proof of coverage letter to keep with you until your new card arrives. 
  • To find the letter, click the benefits/coverage details button in the Member Resource Center, then click continue to be redirected to your benefit summary. On the right, you will see a link that says, “Hover here for a link to view your Outline of Coverage.” Click the link to download a PDF of the letter.

Q: How much does a new ID card cost?
A: New ID cards are always free to members.

Q: I have two ID cards; how do I know which is the right version?
A: You can check for the most recent effective date listed on the lower left side of your card.

Q: My doctor’s office requested I pay the co-pay on my current card, but my 2022 plan has a different co-pay. Will I be reimbursed?
A: If you are seeing an in-network provider, they are responsible for the difference.

Q: Can I get my prescription filled without my card?
A: Yes. If you have prescription coverage, when contacting the pharmacy to fill your prescription, please let them know that you are a member with Blue Cross and Blue Shield of Vermont. If you don’t have your member ID number, they may ask you for your date of birth and address to confirm your eligibility and coverage. 

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