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, 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!