This week, we’re featuring several New Year’s resolutions you can implement now to help control your healthcare expenses.

Insurance companies, hospitals, and medical providers sometimes make claim and billing errors. These mistakes can have serious consequences. The first step in uncovering these errors is checking your
Explanation of Benefits (EOB).

After receiving medical treatment, you will receive an EOB from your insurance company. The EOB will come in the mail or, if you signed up for electronic notifications, you will receive an email notifying you it’s
available to view online. Either way, check it. 

The EOB will show:

  • What was billed
  • Any provider discounts
  • What the insurer paid
  • What you may owe the provider

If the EOB notes that you have financial responsibility, you should receive a medical bill from your provider soon. If you do not, you’ll want to follow up with your provider. 

When reviewing the EOB, ask yourself the following questions:

  • Did you receive the services listed?
  • Are the dates of service correct?
  • Do you notice any problems with the diagnosis or procedure codes?
  • Do the provider discounts look correct and correlate with your past experience?
  • Do the insurance company’s payments correspond with your policy?

When you receive your bill, make sure to compare it to the EOB. If the bill is higher than the EOB, try to figure out what the problem is. You may want to start by calling your insurance company. If your insurer agrees that you were overbilled, you should inform the provider of the discrepancy by emailing a copy of your EOB to the customer service department. If the provider tells you it received a different EOB from your insurer, you’ll need to make sure your insurer is relying upon the correct information. I’ve seen on
multiple occasions that some providers rely upon information obtained not from the insurer but an electronic clearinghouse that often provides incorrect information.

You may need to get your insurance company representative on the phone and conference in the provider’s customer service department. This sometimes, but not always, resolves the problem. It’s possible the provider will submit the issue to their insurance department for further review.

The bottom line is you should not be paying more than what your EOB says you owe. If the bill is higher than the financial responsibility listed on the EOB, there’s likely a problem with the bill. By reviewing your EOB every time, you may save yourself money on healthcare costs in 2021.  

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Manta Law 2024. All Rights Reserved.

Manta Law 2024. All Rights Reserved.