How to Read Your Explanation of Benefits

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 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. 

MVP Health Plan, Inc. is an HMO-POS/PPO/HMO D-SNP organization with a Medicare contract and a contract with the New York State Medicaid program. Enrollment in MVP Health Plan depends on contract renewal. MVP Health Plan, Inc. has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 12/31/2024 based on review of MVP Health Plan’s Model of Care. Health benefit plans are issued by MVP Health Plan, Inc., an operating subsidiary of MVP Health Care, Inc. Not all plans available in all states and counties. Every year, Medicare evaluates plans based on a 5-star rating system. Out-of-network/non-contracted providers are under no obligation to treat MVP Health Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. For accommodations of persons with special needs at meetings, call 1-800-324-3899 (TTY 711).

Other physicians/providers are available in the MVP Health Care network. Gia virtual care services are available at no member cost-share for medical plans, including qualified high-deductible health plans (QHDHPs). Exceptions may apply for self-funded plans. In-person visits and referrals are subject to cost-share per plan. Members enrolled in a Medicare Rx plan without additional MVP medical coverage do not have access to MVP virtual care services through Gia. SilverSneakers is a registered trademark of Tivity Health, Inc. SilverSneakers On-Demand is a trademark of Tivity Health, Inc. ©2023 Tivity Health, Inc. All rights reserved. GetSetUp is a third-party provider and is not owned or operated by Tivity Health, Inc. (“Tivity”) or its affiliates. Users must have internet service to access online services. Internet service charges are responsibility of user.

TruHearing® and (RE)TM are trademarks of TruHearing, Inc. All other trademarks, product names, and company names are the property of their respective owners. Retail pricing based on prices for comparable aids. Follow-up provider visits included for one year following hearing aid purchase. Free battery offer is not applicable to the purchase of rechargeable hearing aid models. Three-year warranty includes repairs and one-time loss and damage replacement. Hearing aid repairs and replacements are subject to provider and manufacturer fees. For questions regarding fees, contact a TruHearing hearing consultant.

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Last Updated: 3/1/2024

Speak to a Representative

To shop for a plan, contact an MVP Medicare Advisor at 1-800-324-3899 (TTY 711)

For questions about your plan, contact the MVP Medicare Customer Care Center at 1-800-665-7924 (TTY 711). If you have an MVP DualAccess plan, call 1-866-954-1872 (TTY 711).

From April 1-September 30, reach us Monday-Friday, 8 am-8 pm. 

From October 1-March 31, reach us seven days a week, 8 am-8 pm.