Have You Checked Your EOB Lately?

Have You Checked Your EOB Lately?

It can cost you money if you don’t review it!

What is it about insurance that makes us run in fear or hold up our hands in frustration hoping to avoid the issue? Is it the expense…the challenge…or the complexity of insurance? Regardless of how you feel about insurance, you should still understand how your insurances works to ensure you receive entitled coverage. For example, do you regularly check the EOB (Explanation of Benefits) statement that your insurance company sends to you following a medical procedure or doctor’s appointment? If you’re not, then you should reconsider and make a habit of checking the statement for accuracy. There could be medical billing errors driving up the amount of money you owe so learning how to read an EOB could be a cost-saving effort on your part.

Why Review an EOB

Each time you receive any medical service, from a simple check-up with your primary care physician to a complicated hospital admission, your insurance company will send you an Explanation of Benefits statement. Your insurer prepares an EOB after a medical provider has filed a claim with your insurance company. While an EOB is not a bill, the statement is just as important since it summarizes medical fees and insurance benefits based upon your coverage. 

You want to check the statement for two very important reasons: 1) Ensure your insurance company accurately applied your coverage against medical services rendered, and 2) Verify your medical provider correctly reported the treatment you received. By familiarizing yourself with the format and the terminology of an EOB, you will be able to confirm whether the statement is accurate.

What to Review in an EOB

Once you know how to read an EOB, you will be able to detect provider billing errors or denials, an overpayment to the provider, and inaccurate out-of-pocket expenses. When errors are caught early, mistakes are easier to address and resolve.

While it is important to review the entire EOB statement, the information in the middle section of the EOB itemizes provider fees and covered benefits. Included in this section are the charges billed by the provider and approved by your insurance company. The statement will show whether you are owed some money, or if you need to pay your medical provider for uncovered costs.

This section should be carefully reviewed by you since there could be mistakes. You want to make sure that your claim was accurately processed, and coverage benefits correctly applied to avoid unnecessary charges. In fact, according to CareCredit, some of the most common billing errors include:

  • Charges for services not received
  • Errors with deductible amounts
  • Wrong amounts charged
  • Services double billed
  • Wrong service dates

If you see errors like these or anything else suspicious, there are steps you can take to appeal a claim.

How to Appeal EOB Errors

When you find errors on your EOB, you will want to file an appeal to your insurance company. The steps to appeal a claim include:

  • Contact the insurance company to notify them of errors
  • Submit a written appeal/dispute to the insurance company
  • Contact the medical provider’s billing department to advise of any mistakes and obtain an appeals form
  • Submit a written appeal/dispute to the provider

It’s important to keep a log of names, dates, telephone, and reference numbers for each insurance and/or provider contact related to your claim. You can handle the appeal process yourself or enlist the services of an experienced health advocate, like Human Health Advocates, which has extensive experience handling health insurance appeals and medical bill reduction.

If you find an error on your EOB and need assistance with disputing charges on a statement, contact Human Health Advocates for help. Human Health Advocates, LLC, located in Boca Raton Florida, serves clients both statewide and throughout the nation. It is a very highly reviewed entity and affiliated with the Better Business Bureau. Its members are Board-Certified Patient Advocates who specialize in medical debt reduction. If you are having difficulty understanding or managing your medical bills and/or health insurance Explanation of Benefits (EOB’s), reach out…..get help…..contact one of our Board-Certified Patient Advocates. We review medical bills and health insurance determinations to locate errors in providers’ charges and processing.  We prepare insurance appeals for denied claims. We negotiate reductions in your medical debt from hospitals and other medical providers. If you have problems with your medical bills or health insurance, get in touch. WE CAN HELP!

By Human Health Advocates

Health Insurance Terms Exposed

Health Insurance Terms Exposed

Does health insurance terminology seem like a foreign language to you? Does your mind go blank when you hear words like co-pay, deductible, and out-of-pocket expenses? If you’re nodding your head in agreement, welcome to the club. There are many other people like you who are confounded by insurance and treat it like it’s a necessary evil. However, if you’re letting the insurance company or your medical provider dictate your insurance coverage because you don’t understand your policy, you might be depriving yourself of benefits or coverage you’re entitled to receive. Knowing your insurance policy and its terminology is an advantage you do not want to ignore since it could cost you some precious dollars and possibly medical care.

A simple way to look at health insurance terminology would be to separate it into two categories: 1) Costs; and 2) Medical Coverage. Familiarizing yourself with the vocabulary used in your policy will help you to understand your financial obligations and coverage rights. In fact, starting with the following ten terms might provide you with enough insight to help you manage your health coverage more effectively.

Need to Know Costs

  • Premium – The amount paid for insurance coverage. A premium can be paid monthly or quarterly, or even annually, depending on the preference of the policy owner. The premium is separate from the out-of-pocket expenses such as deductible, coinsurance, and annual out-of-pocket maximum
  • Deductible – The amount paid by the policy owner for a medical service covered by an insurance policy. After the deductible is reached (for example, $6,000 for a single person), the insurance company pays an agreed portion of each expense; until the out-of-pocket amount is reached. Keep in mind that the deductible amount affects an insurance premium. The inverse relationship results in higher the deductible, the lower the premium; the lower the deductible, the higher the premium.
  • Coinsurance – Percentage of covered services that the policy owner and insurer pay. Coinsurance is applied after the annual deductible is has been met. For example, our $6,000 deductible with an out-of-pocket maximum of $7,400, you receive a $ 23,000 hospital bill. Insurance negotiated rate is $8,000. You pay the first $6,000 (deductible). Coinsurance may be 80/20- so the insurer would pay the next $1,600 (80% of remainder), and you would pay $400 (20% of remainder, after deductible).
  • Co-Payment – A fixed dollar amount paid for an in-network covered service. Examples of co-pays include the fee paid for a doctor appointment ($35 for specialist) and prescriptions ($10 co-pay).
  • Annual Out-of-Pocket Maximum – The maximum amount of money paid by the insured over a policy year. The expenses applied usually include copayments, deductibles, and co-insurance. Once met, all covered in-networkservices should be paid by the insurer at 100% for the remainder of the calendar year.

Need to Know Coverage

  • Referral – Necessary with HMO coverage to obtain from Primary Care Physician to see a specialist, have an MRI, and to receive other services.
  • Preauthorization – The primary care doctor or specialist submits a request to the insurance company for preauthorization for certain medical services (MRI, time in a hospital, etc.). Although issued by the insurance company; it still does not guarantee they will pay for the service. However, failure to obtain one in a non-emergency situation (say you have an MRI at your doctor’s office which did not obtain the necessary preauthorization) could make you responsible for up to 100% of the procedure’s cost.
  • Exclusion or Limitation – Exclusion refers to services or supplies the insurance company will not approve; for example, cosmetic plastic surgery may be a policy exclusion. A limitation is a similar clause, setting forth exceptions to coverage, with specific qualifications. Traditionally, limitations are in connection with PRE-EXISTING CONDITIONS. If you have an: “Obamacare” policy you need not worry about these while the Affordable Care Act is law. PLEASE read these clauses CAREFULLY—they can have disastrous results.
  • Denial – Refusal by the insurance company to approve a service or pay a claim.
  • Allowed Amount – Agreed upon amount an insurance company will pay a provider for specified medical services or supplies.

Informed Decision-Maker

 When you are an informed decision-maker, you are better prepared to make smart choices regarding medical care and insurance options. You will be taking care of yourself and your family members health, finances, provided you manage your insurance benefits wisely. However, despite best efforts, sometimes we need assistance. With medical matters, seeking assistance from patient advocates like Human Health Advocates leverages expertise in areas including insurance benefits, medical billing (including hospitals bills), and health insurance coverage denials.

Human Health Advocates, LLC, located in Boca Raton Florida, serves clients both statewide and throughout the nation. It is a very favorably reviewed entity and accredited by the Better Business Bureau with an A+ Rating. Its members are Board-Certified Patient Advocates who specialize in medical debt reduction. If you are having difficulty understanding or managing your medical bills and/or health insurance Explanation of Benefits (EOB’s), reach out and contact one of our Board-Certified Patient Advocates. We review medical bills and health insurance determinations to locate errors in providers’ charges and processing.  We prepare insurance appeals for denied claims. We negotiate reductions in your medical debt from hospitals and other medical providers. If you have problems with your medical bills or health insurance, get in touch. WE CAN HELP!

By Human Health Advocates

Know Your Health Insurance Policy

Know Your Health Insurance Policy

Health insurance provides us with a sense of security. We believe it equips us financially to manage health issues from minor to major medical emergencies. But does insurance really secure and protect us? If you don’t know the extent of your medical coverage or your financial obligations, then your sense of protection regarding medical preparedness could be misplaced. You owe it to yourself, your health, and financial well-being to know exactly where you stand with your health insurance. Actually, it’s your responsibility to know and understand your health insurance policy because you should know what to expect and perhaps even demand what to receive.

Insurance Basics

          Having health insurance is not the same as coverage. There are numerous insurance companies, and each offers different types of policies which result in a diversity of coverage limits and costs. Familiarizing yourself with the way your policy works enables you to know the extent and cost of care you, or a family member, are entitled to receive. Also, keep in mind that your insurance policy is a contractual agreement between you and the insurer. If you’re looking for help from anyone to decipher coverage and costs, don’t just turn to the insurance company, but, contact your insurance agent or human resources representative (if you are insured through your employer) to answer your questions. If you need immediate or further assistance understanding your health insurance and financial obligations, then a health advocate could be instrumental in helping you.

 

Plan Options

          The cost of a health insurance policy (i.e., monthly premium) might be the primary criteria that most people use when selecting coverage. Rather than evaluate insurance on its premium fee, instead, it is more sensible to consider the type of health insurance plan you have when evaluating your policy, as well. Plans vary in scope of coverage and flexibility:

  • HMO – Health Maintenance Organization. A good plan if you’re looking for lower out-of-pocket expenses, but little flexibility in the choices of doctors or medical facilities due to limited networks. Selecting a Primary Care Physician (PCP) is required and will issue a referral to a specialist when necessary. There are no benefits for services provided by an out-of-network provider.
  • PPO – Preferred Provider Organization. This plan offers greater flexibility with selecting physicians, and a PCP is not required. Referrals from a physician for a specialist are not required, but some services may require pre-authorization. Doctors, hospitals, and other providers in the plan’s preferred provider list must be utilized in order to take advantage of the lower negotiated rates between insurer and provider.
  • EPO – Exclusive Provider Organization. A combination of HMO and PPO. Like a PPO, doctors are selected from a preferred providers list, and referrals to a specialist are not required. However, there are no benefits for services provided by an out-of-network provider.

Plan Coverage

Next, take a look at your plan to assess whether it meets your personal and family needs. You might already know what type of health insurance plan you have, but if you don’t, take a look at your insurance card for a quick reference. Hopefully, you have a copy of your health insurance policy so you can review your Summary of Benefits. The information in the summary serves as a quick reference guide about your coverage. This summary differs from the Policy Booklet, which is an extensive and detailed explanation of the policy.

The Summary of Benefits presents the scope of coverage concisely and is a useful reference if you want to compare your plan with another one. You’ll be able to assess whether your needs will be met. However, before you start reviewing your plan, you might want to know some key insurance terms:

  • In-Network vs. Out-of-Network:

In-Network: Doctors and hospitals included in a preferred provider list approved by the insurer. These “preferred providers” have negotiated rates, or “allowed amounts,” which provides the insured a discount on covered services.  

Fees for Out-of-Network: Physicians, facilities, or services are not subject to the negotiated allowed amount rates, which can cost you sustainably more.

  • Referral vs. Pre-authorization:

Referrals are provided by a primary care doctor (PCP) to an in-network specialist that will continue care for a specific condition, and insurance company approval is required.

Pre-authorizations are for specific procedures, treatments, or services which may require pre-approval from the insurance company in order to be covered.

  • ACA vs. Non-ACA Coverage:

The Affordable Care Act (ACA), derogatorily referred to as Obamacare Plans, cannot deny coverage based on pre-existing conditions. Which means major pre-existing conditions like diabetes, heart disease/stroke, cancer, COPD, or HIV must be covered under these plans. However, non-ACA plans can and will deny coverage for pre-existing conditions.

The odds of finding one perfect plan for you and your family are not likely. Although it is possible to find a plan that best suits your existing needs, it just takes a little time and research to choose a plan that satisfies cost, coverage, and flexibility. PPOs are good if you prefer the most flexibility, and an HMO or EPO can save you some money on costs. The goal is to assess your specific needs and preferences, then select a policy that is right for your situation.

Human Health Advocates, LLC, located in Boca Raton Florida, serves clients both statewide and throughout the nation. It is a very highly reviewed entity and accredited by the Better Business Bureau with an A+ rating. Its members are Board-Certified Patient Advocates who specialize in medical debt reduction. If you are having difficulty understanding or managing your medical bills and/or health insurance Explanation of Benefits (EOB’s), reach out…..get help…..contact one of our Board-Certified Patient Advocates. We review medical bills and health insurance determinations to locate errors in providers’ charges and insurer’s processing.  We prepare insurance appeals for denied claims. We negotiate reductions in your medical debt from hospitals and other medical providers. If you have problems with your medical bills or health insurance, get in touch. WE CAN HELP!

4 Smart Steps To Take If Your Medical Bill Goes Into Collections

4 Smart Steps To Take If Your Medical Bill Goes Into Collections

By the time a collection agency contacts you about an overdue medical bill, you might have forgotten about the debt or perhaps even hoped the healthcare provider had overlooked the unpaid account. Unfortunately, financial issues don’t disappear– in fact, they could even get worse. So instead of burying your head in the sand and ignoring the matter, step up and consider a course of action that is in your best interests. Often, it’s the individuals accountable for their financial obligations, which might get a chance at working out a satisfactory arrangement. Whether you’re currently dealing with a debt collections issue now or know someone who is, there are some specific actions which can help you to manage the situation.

With corrective action, you might even be able to prevent the debt from damaging your precious credit. Be proactive and initiate action since this kind of attitude could help you to avoid any surprises that might hurt you financially.

Step 1: Obtain Information

When you first receive a collections notice, you want to verify the debt is correct. Call the collections agency and get as much information about the original creditor, service dates, and amount owed. Minimally, request the name of the original creditor (hospital or provider) and obtain contact information including address and telephone number. Most importantly, request an itemized statement with coding for the amount sought. If the agency doesn’t have this, then you might need to obtain the information from the original creditor. You have the right to collect this information so be persistent with your request. A recent article by Credit.com states that “it’s quite common for collections agencies to make mistakes regarding the debt they claim you owe.” You have 30 days from the date of the initial collections notice to request validation of or dispute the validity of the debt.

Step 2: Submit a Dispute

          If you believe the debt is not valid, you have the right to submit a dispute with a collections agency. In its first communication with the debt holder, a collections agency must not only state they have taken over the account but must also provide the consumer with an opportunity to contest the debt. Don’t delay since you have only 30 days from receipt of a collections letter to file a dispute. While the dispute is under investigation, the collections agency must suspend activity on the account. As explained in a June 2019 article in NerdWallet, an agency “can’t put the issue on your credit reports. If it finds the debt valid, the collector will mail you documents verifying the bill. If not, it will stop attempting to collect the debt.”

Step 3:  Verify Credit Reporting

          Not all collections agencies are created equal. Ask if the agency reports to any of the three credit bureaus (Experian, Equifax, or TransUnion). A collections agency can be either internal or external to the medical provider. There is an important difference between the two, so it’s to your advantage to ask this question. If the agency is internal to the provider, there is a higher probability of certain success with an internal department. You have a greater chance of having your debt removed from collections, correcting errors, and, depending on your circumstances, obtaining a higher discount amount.

Step 4: Negotiate A Resolution

          After you’ve verified the amount is correct, the next step focuses on the handling of the debt. At this point, you might want to consider negotiating a payment plan or a lump-sum discount. However, it’s important to negotiate a manageable amount that is affordable for you. Otherwise, it won’t be possible to make the promised payments. It’s also to your advantage to request 0% interest and confirm the credit agency will suspend reporting to the credit bureaus while you make payments.

You Have Rights

Consumers are entitled to certain rights as stated in the Fair Debt Collections Practices Act. Knowing these rights can be a powerful resource when dealing with collections agencies. A June 2018 article by Consumer Reports points out that “patients need to be able to question bills without damaging their credit rating—and also have reasonable payment options when a bill swamps their budget.” However, medical debt resolution can be a daunting prospect, especially with a complex case. In these situations, getting help from medical billing advocates like Human Health Advocates would provide expertise and peace of mind that can be priceless.

Human Health Advocates, LLC, located in Boca Raton Florida, serves clients both statewide and throughout the nation. It is a very highly reviewed entity and affiliated with the Better Business Bureau with an A+ rating. Its members are Board-Certified Patient Advocates who specialize in medical debt reduction. If you are having difficulty understanding or managing your medical bills and/or health insurance Explanation of Benefits (EOB’s), reach out…get help…contact one of our Board-Certified Patient Advocates. We review medical bills and health insurance determinations to locate errors in providers’ charges and processing.  We prepare insurance appeals for denied claims. We negotiate reductions in your medical debt from hospitals and other medical providers. If you have problems with your medical bills or health insurance, get in touch. WE CAN HELP!

You Snooze You Lose

You Snooze You Lose

We don’t have the luxury of time for hospital fee comparisons when a medical emergency strikes. If we did, we would shop around first for the most cost-effective pricing before setting foot in a hospital. However, reality is different. We’re grateful for medical intervention in times of a health crisis and direct our focus to intervention, treatment, and recovery with little thought of the associated cost. Indeed, financial reality might not hit us until we receive the first medical bill, and it’s then when we become aware of the price tag we pay for medical care.

Reactions such as ignoring a hospital bill or reaching for a credit card should not be your immediate response. Instead, realize that there are some things you can do to manage medical expenses, and as a result, a favorable outcome could be worked out. All it takes is a few thoughtful steps on your part.

Prompt Action

Providers such as medical facilities and physicians must wait 180 days before they can report a medical bill to a credit bureau, but they could send your bill to a collection agency at any time. You do want to follow up with your provider promptly when you receive a medical bill, but before you do this, you also want to have a copy of the Explanation of Benefits from your insurance company (Medicare calls theirs a Medicare Summary Notice – MSN). You need both documents to review for any medical billing errors and accurate deductions. If you see a discrepancy on either of these bills, you only have a limited time for an error to be corrected so don’t delay. If there are errors, don’t forget to report this to your insurance company so the claim can be adjusted. Report and appeal any discrepancies to your medical insurance company within a specific timeframe; fortunately, information about deadlines for appeals are included in the EOB from your insurer.

Two-Way Communication

If you do find an error or have a question about any item billed by a medical provider or processed by your insurance company, contact the medical provider’s billing department or insurance claims office about the error or question. With your provider, request a suspension of the billing cycle or collections effort until the matter is resolved. In fact some states, such as Florida, mandate that providers (in certain circumstances) must suspend the collections efforts until the problem gets resolved. This would be a matter to research if you encounter a medical billing issue or if you work with a medical billing specialist like Human Health Advocates, ask them to look into this for you.

Payment Options

Fortunately, with medical debt, it doesn’t have to be a “pay everything now” proposition. Payment options do exist, however, the chances of negotiating a settlement are greater when the debt is not too old. The same is true of a single lump-sum payment at a reduced rate. A payment plan or discounted fee can be negotiated after the amount owed has been confirmed. Once a payment arrangement has been determined, request 0% interest and ask for the account to remain with the provider until it is paid off. To make sure the debt is not forwarded to a collection agency, document the commitment by having the provider sign a pledge not to report your debt. Your part is to make all payments in a timely manner.

Right to Dispute

If you disagree over the amount charged to you, then file a dispute against the provider to reduce medical bills. For billing discrepancies such as erroneous charges or services, send a dispute letter to the healthcare provider. You would also want to send a separate letter about the disputed charges to your insurance provider. Keep copies of all the documentation that you send since you’ll want to reference it when you conduct a follow-up. You can always contact a medical billing advocate like Human Health Advocates to handle a dispute for you. Whether you enlist the assistance of an expert or handle the matter yourself, your best first course of action is opening the medical bill envelope as soon as you receive it.

Human Health Advocates, LLC, located in Boca Raton Florida, serves clients both statewide and throughout the nation. It is a very highly reviewed entity and affiliated with the Better Business Bureau. Its members are Board-Certified Patient Advocates who specialize in medical debt reduction. If you are having difficulty understanding or managing your medical bills and/or health insurance Explanation of Benefits (EOB’s), reach out…get help…contact one of our Board-Certified Patient Advocates to schedule your FREE CONSULTATION. We review medical bills and health insurance determinations to locate errors in providers’ charges and processing.  We prepare insurance appeals for denied claims. We negotiate reductions in your medical debt from hospitals and other medical providers. If you have problems with your medical bills or health insurance, get in touch. WE CAN HELP!

 

By Human Health Advocates