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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.

Contact us

UPMC for Life Members
Call us toll-free: 1-877-539-3080 (TTY: 711)

Oct. 1 – March 31: 
Seven days a week from 8 a.m. to 8 p.m. 
 
April 1 – Sept. 30: 
Monday through Friday from 8 a.m. to 8 p.m. 

UPMC for Life Prospective Members
Call us toll-free: 1-866-400-5077 (TTY: 711)
Oct. 1 – March 31: 
Seven days a week from 8 a.m. to 8 p.m. 
 
April 1 – Sept. 30: 
Monday through Friday from 8 a.m. to 8 p.m. Saturday from 9 a.m. to 3 p.m.

This information is not a complete description of benefits. Call 1-866-400-5077 (TTY: 711) for more information. Out-of-network/Noncontracted providers are under no obligation to treat UPMC for Life 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. Other physicians/providers are available in the UPMC for Life network.

This information is available for free in other languages. Please call our customer service number at 1-877-539-3080 (TTY: 711).

UPMC for Life has a contract with Medicare to provide HMO, HMO D-SNP, and PPO plans. The HMO D-SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., UPMC for You Inc., and UPMC Health Coverage Inc.

SilverSneakers is a registered trademark of Tivity Health Inc. SilverSneakers GO is a trademark of Tivity Health Inc. © 2024 Tivity Health Inc. All rights reserved.

UPMC for Life Members
Call us toll-free: 1-877-539-3080
TTY: 711

Oct. 1 – March 31:
Seven days a week from 8 a.m. to 8 p.m.

April 1 – Sept. 30:
Monday through Friday from 8 a.m. to 8 p.m.

UPMC for Life Prospective Members
Call us toll-free: 1-866-400-5077
TTY: 711

Oct. 1 – March 31:
Seven days a week from 8 a.m. to 8 p.m.

April 1 – Sept. 30:
Monday through Friday from 8 a.m. to 8 p.m. Saturday from 9 a.m. to 3 p.m.

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Last Updated: 10/01/2024