Explanation of Benefits

An Explanation of Benefits (EOB) form will be sent to you and your health care provider whenever a claim is submitted. EOBs provide you with information that details how much of your claim will be paid by your insurance carrier and whether you are responsible for a balance due.

Detailed samples of EOBs are provided for your convenience below. If you have questions about your EOB, please contact a member service representative.

Sample Explanation of Benefits (PDF) 

PDFs require Adobe^® Reader^®

Appeals and Concerns

If you have concerns about the quality of care you have received, have complaints about your health plan service, or if you wish to appeal services or coverage that is denied, reduced or terminated, please send your request and any supportive documentation to:

Nationwide
PO Box 30266
Tampa, FL 33630-3266

Report Fraud

Health care fraud is a problem that affects everyone. Dollars lost to fraud result in higher premiums. Nationwide is committed to the fight against fraud and you are a valuable resource. Please be vigilant and report fraud whenever you suspect it.

What information is required to report fraud?

In order to fully investigate your allegation, we will need as much of the following information as you can provide:

• Name of the person or health care provider suspected of being involved in the fraud, including the address if known
• Date(s) of service and claim number(s) in question
• Patient's name and member number
• Narrative description of the allegation. Include as much detail as possible.
• Your name
• Your telephone number or e-mail address if we may contact you

What happens after fraud is reported?

• You will receive an acknowledgement of your referral when Nationwide Special Investigations Unit* receives your allegation
• Each allegation will be investigated. You may be contacted for additional information.
• You will be advised of our findings when the investigation is complete

_{*Once received, the identity of the complainant or member will be kept strictly confidential.}