Example of RSI Statement

The RSI Explanation of Benefits (EOB) RSI’s Explanation of Benefits (EOB) shows your final plan liabilities, as well as: • Patient name • Date of service • How much is owed • How much was paid • The provider from whom you will receive a bill • Where you are in your deductible to date Before you pay any medical bill, be sure it matches the RSI Explanation of Benefits If it’s red, read it! 17

Example of RSI Statement - Page 1 Example of RSI Statement