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

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!

Biggest Flash Points In The Graham-Cassidy Health Care Bill

Biggest Flash Points In The Graham-Cassidy Health Care Bill

From www.npr.org: If Senate Republicans vote to repeal and replace the Affordable Care Act this week, it would affect the health care of pretty much every American.

Here’s a recap of four key flash points in the health overhaul debate with links to NPR coverage over the past six months, and our chart laying out how the Graham-Cassidy bill under consideration in the Senate addresses those issues compared with the Affordable Care Act.

Pre-existing conditions. One of the biggest issues in the repeal/replace debate has been coverage for pre-existing conditions, genetic risks and chronic illness. Before the Affordable Care Act, insurers could deny coverage to people with diseases like diabetes or charge them much higher premiums. The ACA requires insurers to cover pre-existing conditions without charging more. The GOP bills passed or proposed would give states the power to waive that requirement. People with disabilities or chronic diseases, people who have had cancer, and parents of children born with health problems like late-night host Jimmy Kimmel say that could make insurance unaffordable.

Medicaid. The federal/state insurance program provides health care for 20 percent of all Americans, including 40 percent of children, half of all births, 60 percent of nursing home expenses and 25 percent of mental health care. The Graham-Cassidy bill would transform the structure of Medicaid, giving states control over how they spend federal funds. The bill cuts Medicaid funding over time. States that expanded their Medicaid programs, including California and New York, would face the biggest cuts, while Texas and some states in the Deep South and West would fare better.

Essential Health Benefits. The Affordable Care Act requires that insurers cover 10 “essential health benefits,” including maternity care, mental health,Health Advocates hospitalization, prescription drugs, emergency care, and children’s health. The GOP proposals would let states opt out of those requirements, affecting insurance sold on the exchanges and employer-based coverage. But economists say that won’t lower health costs as much as the bills’ backers may hope, since the three biggest drivers of health costs are hospital care, doctor visits and prescription drugs — three things states may be most reluctant to cut.

Uncertainty And Market Instability. As far back as April, insurers were worried that they wouldn’t have enough time to set rates for 2018. That fear has only increased. Earlier this month, entrepreneurs said the lack of clarity is interfering with hiring. Enrollment on the federal exchanges opens Nov. 1, though the Trump administration has cut advertising for open enrollment by 90 percent. Some private insurers are stepping up to fill the gap.

The full article is available by clicking here: NPR

Who Wins, Who Loses With Senate Health Care Bill

Who Wins, Who Loses With Senate Health Care Bill

Would you like to have a clearer picture of the tremendous negative effects of the proposed  Republican Health Bill(“Better Care Reconciliation Act”)? Review the following chart and article from NPR for some clearly-presented information. There is nothing BETTER about this than the ACA! This provides LESS CARE than mandated by the ACA! This will cost patients MORE than under the ACA! This will cause more than 20,000,000 people to lose coverage! This is barbaric! Congress has no soul.

PLEASE—WRITE AND CALL YOUR Senators and tell them to VOTE NO!  It’s not too late.  It’s just plain wrong to take away insurance from tens of millions, reduce coverage, and raise costs—all so people that can afford great insurance can pay less taxes. Health care should be a right—available to all—regardless of economics or politics! SPEAK UP NOW! Later might be too late.

CLICK HERE for full NPR article.

This chart illustrates how the plans compare:

People under 26
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Can get insurance through a parent’s plan or buy independently. Stays the same. Stays the same.
Adults under 65
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Can buy insurance on health exchanges, with tax credits and subsidies if they meet income requirements up to 400 percent of poverty level. Cost of insurance is based on tobacco use and age, with the people nearing 65 paying no more than three times what the youngest pay. Premiums can’t cost more than 9.5 percent of income. Those with very low or no income qualify for Medicaid. Will see tax credits to pay premiums based on age, not income, and that max out at $4,000, much less than under the ACA. The oldest people under 65 can be charged five times more than the youngest, and maybe more depending on state rules. Medicaid cut after 2020. The CBO report says 22 million people would lose health insurance over the next 10 years, with people between 50-64 disproportionally impacted. The oldest people under 65 would pay five times more than younger people on the exchanges.Subsidies to help pay for insurance would be less and end at incomes of 350 percent of poverty level. Federal contributions to Medicaid start to decline in fiscal year 2020.
Low-income nursing home residents
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Skilled nursing care covered by Medicare up to 100 days. Medicaid is available based on income. Skilled nursing care covered by Medicare up to 100 days. Medicaid services could be cut as states see federal funding decline. Skilled nursing care covered by Medicare up to 100 days per illness. Medicaid coverage for nursing home services could be cut as federal payments to states decline.
People with pre-existing medical conditions
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Coverage cannot be denied or cost more. States can get permission to let insurers charge more for some pre-existing conditions and to exclude some people altogether. States would have access to federal money to help those with expensive policies or conditions. Insurance companies would be required to accept all applicants regardless of health status. But the draft bill lets states ask permission to reduce required coverage, also called “essential health benefits,” which would give insurers some discretion over what they offer in their plans. That could result in “substantial increases” in costs for people who want those services, according to the CBO. If a particular benefit is no longer classified as essential, insurers could impose annual and/or lifetime limits on what they spend on patients for that benefit. And caps on the annual out-of-pocket costs for patients would no longer apply.
People who go to Planned Parenthood
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Federal programs reimburse for most Planned Parenthood services. A one-year block will be placed on federal reimbursementsfor care provided by Planned Parenthood. A one-year block will be placed on federal reimbursementsfor care provided by Planned Parenthood. The CBO estimates 15 percent of women would lose access to family planning care, increasing birth rates and Medicaid spending for childbirth and children’s insurance. But those increases would be offset by Planned Parenthood cuts.
People with disabilities
The majority of Medicaid dollars go to people with disabilities.
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
May qualify for Medicare and also Medicaid. Services covered by Medicaid could be cut as federal funding to states declines over time. Services covered by Medicaid could be cut as federal funding to states declines over time. The CBO report suggests that by 2026, Medicaid enrollment would fall by more than 15 million people.
People who use mental health services
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Covered by all plans under essential health benefits. Could lose coverage in states that get waivers from covering essential health benefits. States could request waivers to opt out of requiring essential health benefits. If a state opted out of coverage for mental health care, the CBO says insurance that includes mental health care coverage could become “extremely expensive.”
Working poor on Medicaid
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Thirty-one states and the District of Columbia offer expanded Medicaid coverage. Federal funding for Medicaid expansion phases out, potentially affecting millions of people who are currently enrolled under the expansion. Federal funding for Medicaid expansion phases out between 2021 and 2023. In addition, eight states would have a trigger clause — if the federal matching rate declines below the ACA-promised rates, the expansion goes away immediately in Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington. Further reductions would start in 2025. In a separate provision, states could impose a work requirement on recipients. Most able-bodied adult Medicaid recipients already work.
The wealthy
AFFORDABLE CARE ACT (OBAMACARE)
HOUSE BILL: AMERICAN HEALTH CARE ACT
SENATE DRAFT: BETTER CARE RECONCILIATION ACT
Pay extra taxes to support ACA. The bill would repeal ACA taxes on corporations and cut taxes for the wealthy by about $592 billion. Similar to the House bill; would repeal ACA taxes on corporations and the wealthy that pay for insurance subsidies. That would add up to about $563 billion in tax cuts over 10 years, according to the CBO.

Florida Law Shields Patients from Surprise Medical Bills

florida-capitolThe Florida Legislature passed (signed by Governor Rick Scott) a bill that may be the most consumer-friendly in the country concerning “Balance Billing.“ Yes—FLORIDA.

Balance Billing was previously illegal in Florida for both Medicare and HMO patients but led to financial havoc for thousands of Floridians with PPO coverage. Simply, a patient who went to an in-network hospital’s emergency room. However, many doctors, although affiliated with the hospital, were not “in-network” for these patients.

The treating emergency room doctor (whom the patient had no option in choosing) submits a “full-price bill say $1,200 to the insurance company. It would cover it’s normal negotiated rate- say $300.

As a result of having no way to choose their doctors, thousands of patients were pursued by medical billing companies (many of which were ruthless about pursuing the patient into collections, negative credit reporting, and sometimes lawsuits). This doesn’t mean that all medical bills will not be vigorously pursued. But they will no longer be pursued as the product of balance billing.

That has changed- Thank you Florida Legislature for “doing the right thing.”

Click here to read Florida Statute  627.64194