Compare Your Hospital Bill to the Explanation of Benefits
Medical billing errors are common, as we recently noticed . One way to catch a billing error is to check the charges against your health insurance company (EOB) explanation of benefits.
According to HealthInsurance.org, an EOB is “a written explanation from the insurance company about a claim, showing what they paid and what the patient is expected to pay. “ This is not an expense in itself, but it will tell you in detail what exactly you still have to pay out of your pocket for. Your insurance company is required to send you an EOB each time a file is requested for your treatment.
This is helpful when it comes to medical billing errors because you can reconcile them with the bills sent to you by your doctor or other health care provider. Then you can see, for example, if you were double-billed or charged for procedures or services that you never received.
What to check in explaining benefits
There are several different things to check on your EOB when you receive it. HealthValues.org has some good explanatory and example text:
1. The first thing to check is if your doctor is listed correctly so that you are not overcharged if, say, an incorrectly named doctor is out of the network or was a specialist when you visited a general practitioner. “If you see more than one doctor, make sure the doctor listed on the EOB matches the date of the service you actually visited that doctor,” writes HealthValues.org.
2. By the way, make sure that the service date is the same as the date when you actually visited the doctor.
3. Then look at “Accruals”. This is the total cost of your care. “Allowed amount” is what you actually have to pay after the preferred provider discount if you qualify for on-net service, ”writes HealthValues.org.
4. But this does not mean that you will pay as much as indicated in # 3. Section # 4 above details the size of your debt by co-payment, deductible, and co-insurance. In the example above, the patient was hooked for $ 216.92 after the insurance discount. Then the figure of $ 43.76 is what is left of the patient’s deductible.
That leaves $ 173.16 ($ 216.92- $ 43.76) after the deductible has been reached. In this case, the patient’s co-insurance is 20 percent, so he will pay $ 34.63, which is 20 percent of that $ 173.16. Thus, together with the deductible, the patient owes $ 78.39.
Check for errors
One important thing to check on your EOB, CNBC reports , is that “the discounted rate for your network doctor or other provider should be the starting point for any co-insurance or deductible you are responsible for,” not full fees as indicated in # 3 above.
So in the example above, your deductible is applied after the $ 113.08 on-net rebate is applied to your $ 330 total bill. Then your co-insurance applies.
If you get a bill from a doctor who charges you more than your EOB, “follow the insurer’s directions,” CNBC writes.
However, be aware that your EOB may contain an error. Let’s say your physical health needs to be 100% covered by your plan, but you still have to pay. In this case, you need to call your insurance company.