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EOB Information Area This area contains your EOB number, Participant Number, and your group number and name information. All of this information is important if you need to call Butler with any questions!

Explanation of Benefits An "Explanation of Benefits" or "EOB" form is the means by which we notify you, the participant, how your claims have been paid. These can be either mailed or made available through our Butler Information Network in a secure electronic format.

Participant Address Area This is where an EOB is addressed to if mailed. This is the address we have on file for you, so if it is incorrect, please let us know.

Butler's Address If you need to send any correspondence via the US Mail, use this address. Our physical location is in the historic Putnam building at 215 North Main Street, Suite 800, in downtown Davenport, Iowa 52801.

Procedure This is the lay description of the service that was performed. Typically is related to a CPT Code, a Revenue Code, and Dental ADA Code.

Date of Service The Dates of Service that this particular EOB Covers. It is possible that the same dates of service may come in under several EOB's.

Charge Amount The Charge is the cost of the service as billed by the provider. This amount does not include PPO Discounts, Reasonable and Customary edits, or any ineligible charges. This amount is also totaled for this claim and provider.

Ineligible Amount This amount represents the amount that was not paid and may include PPO Discounts, Reasonable and Customary edits, or any ineligible charges. This amount is also totaled for this claim and provider. Be sure and check the references section to see if this amount may be your responsibility!

Reference Code The Reference Code relates to the Reference code table that will provide a further explanation about any amount in the "Ineligible" column. Check the reference table to see if you may owe your provider additional amount.

Deductible Amount This amount is the amount of this claim that applied to the deductible. This amount is also totaled for this claim and provider. Be aware that some health plans have different deductibles for in and out of network charges!

Copay Amount This amount represents the copay for this service, which you are responsible for. This amount is also totaled for this claim and provider. In some cases a copay is taken by date, by provider, or other criteria. Check your Summary Plan Description to see which services have a copay and how the copays are applied.

% Paid (Coinsurance) This is the percentage that your health plan paid for on this claim, typically applied after any deductibles or applicable Copays. This amount is also totaled for this claim and provider. Some health plans have varying levels of coinsurance for different services, even if they may be billed by the same provider!

Paid To This is the who the payment was made payable to, typically either the "Claimant" or "Provider".

Paid Amount This amount is the amount that was paid on this claim. This amount typically is the Provider's Charge less Ineligible charges (PPO Discounts, R&C Adjustments, and Non Covered Expenses), Deductibles, Copays, and Coinsurance.

Member Owes Amount This is the amount that you are responsible for. Many times this amount will have a cap, called your out of pocket limit.

Claims Examiner With claims processed by Butler, you can call and talk to the person that actually processed your claim and is familiar with your health history.

Patient Info Each claim on an EOB starts with complete Patient Information including the Patient Name, Birthdate, and the Provider Name. A patient can be you or any of your covered dependents.

The Reference Table This table states the full reason for the ineligible charges in the above referenced claims. This may include things like PPO Network discounts used to "reprice" the claims, non-covered services, or services that have met thier maximums under your plan.

The Deductible/OOP Summary This area is where the Deductibles and Out of Pocket for your entire family are totaled and summarized for however many years as your employer has been with Butler.

Any Questions? Give us a call. The entire staff at Butler is committed to serving you and your health plan. We want you to understand all of the information on this EOB, and we encourage you to call our friendly, courteous staff with any questions. We are after all an extension of your own employer, since we are administrating your employer's health plan on their behalf.