Claims for Benefits. Each time we process a Claim submitted by you or your Health Care Provider, we explain how we processed it in the form of an Explanation of Benefits (EOB). The EOB is not a bill. It simply explains how your benefits were applied to that particular Claim. It includes the date you received the service, the amount billed, the amount covered, the amount we paid, and any balance you're responsible for paying the Health Care Provider. Each time you receive an EOB, review it closely and compare it to the receipt or statement from the Health Care Provider. All Claims for benefits will be deemed to have been filed on the date received by AvMed. If a Claim is a Pre-Service or Urgent Care Claim, a Health Professional with knowledge of the Member’s Condition will be permitted to act as the Member’s authorized representative, and will be notified of all approvals on the Member’s behalf.
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