16 Nov This Is Not A Bill
Welcome back to the last piece of the Are You Covered series.
Are you ready to over the Explanation of Benefits, EOB, Summary of Payments and Summary of Benefits documents? Hold on! Don’t close the tab just yet, let me explain!
Explanation of Benefits = EOB = Summary of Benefits = Summary of Payments
Although these titles all sound daunting, and totally different, they all refer to the same thing! The most common abbreviation for all of these is EOB (Explanation of Benefits), which will be used for the rest of this article. The EOB is a document sent to you by your insurance provider to show what financially transpired behind the scenes of your medical visit.
Now that we have the subject matter defined, let’s dive into what the EOB actually represents.
Although the EOB can be titled and formatted differently, the information contained will always be the same. Our focus for this article is one specific portion of the EOB, the What I Owe section. This section of the EOB outlines the total amount that you are responsible to pay, for the specified visit. Side Note: This amount is paid directly to the provider, you will get an actual bill from the provider with instructions on how to pay the bill. Fortunately, you will get a new EOB for each claim that is processed with your insurance company.
The What I Owe section is the main meat of these letters showing you the amount you will be billed. If you are sent a bill for more than the What I Owe section, an error has been made somewhere and you need to call the provider and possibly the insurance carrier. The agreement between the health care professionals and the insurance company do not allow the providers to bill more than the What I Owe amount. If they do, there is an error somewhere, and you’ve paid too much! Does this sound familiar? If not check out September’s Tidbit!
Checking your EOBs may seem like a massive waste of time.
However, time is money, and checking the EOB after each claim is your way ensure you understand what you are paying is correct. Human error is real, and it happens all the time in the health insurance world. Incorrect coding, missing information or claim denial can all be unnecessarily costly.
Recently, someone called our office in tears over a massive bill from a healthcare provider. This person, let’s call her Polly, thought she did all of her homework. She checked to make sure that the healthcare facility was in-network, checked with the insurance carrier that her procedure was covered, and even calculated her copay and deductible.
Unfortunately, a few months later prepared Polly was in tears over a whopping bill that came from the medical facility. She called the medical provider first to verify her benefits and that the bill wasn’t an error. The facility informed her that there had been no error and the amount billed was the amount due immediately. Instead of paying the bill right away on the phone, Polly decided to call our office.
Our first question:
Have you looked over the EOB from this visit? Does it match the bill that you have from the doctor?
Understandably, Polly had completed all of the homework up to the procedure, but like most people, dropped the ball after the procedure was done. After looking at her EOB for the procedure it looked like Polly owed the facility nothing, zero, nada dollars.
What Polly Owes: $0.00
How could this be? Why was the hospital saying Polly would owed thousands of dollars?
After a quick look over her EOBs and a call to the insurance carrier cleared up this whole mess. As it turned out, the hospital was missing a piece of information from Polly, so they were billing her as if she had no insurance at all. Yikes!
Mistakes do happen, even when you think you’re totally prepared. Take the lesson learned our Polly and compare all of your EOBs side by side with the bills that are sent from the facilities to ensure there has been no errors.