Here’s the deal: The people who bill you for your medical services sometimes make mistakes.
Those mistakes can cost you money.
A good way to make sure you’re paying for the medical services you got is to understand your Explanation of Benefits, or EOB. An EOB looks like a medical bill but is not, and it gives you details on how your insurance company processed medical insurance claims. The EOB tells you what portion of the claim was covered and paid to the provider by your plan. It will also tell you how much, if any, of the bill you are responsible for.
Reading your EOB is not exciting, but it could save you real cash.
You need to read your EOB. Yes, it might take extra time, and it may not be lively reading. But it’s important.
Avoid overpaying for medical care by understanding your EOB.
It’s important to understand your EOB because there are a couple of different errors that can happen. One is an error from a provider. When you get an EOB, you should look it over and compare it to your medical bills to ensure that you are paying the medical provider the right amount. If you find an error on a bill, you should call your provider and explain that your EOB shows a billing error.
The second is an error from an insurance carrier. Similar to billing errors, insurance carriers can make coding errors when processing claims. If you do not understand something on your EOB, or you think your insurance policy should cover a service that was not paid, call your carrier for an explanation or to have the benefit reviewed. In some cases, your EOB may list a Reason Code. A Reason Code will give you the explanation to why a service was not covered, but you may need to contact your carrier to find out what explanation this code responds to.
If you feel confused, this might help.
You might be wondering what you’ll find on an EOB. Here’s an explanation:
Personal Information: You will find information like your name, account number, and more. The most important number for you to note is your Claim Number (or Invoice Number). If you have questions or notice any errors, you will need to reference this number when talking with your carrier.
Provider Information: You will notice the name of the provider of your services. This will be useful because it, along with the date, will tell you which of your doctors bills to associate this EOB with. It is possible that you could receive more than one EOB for each of your medical bills. If this happens, make sure you carefully compare to ensure you haven’t been charged for the same service twice.
Services Provided: The list of services, CPT codes, amount billed and amount approved will all be listed. You will be able to find how much was billed, how much the insurer paid, and how much of your deductible was applied.
Don’t let strange terminology derail your budget.
The list of services provided may look unfamiliar and confusing. If you find this to be an issue, you can use a medical dictionary or do a CPT code search to gain a better understanding of what you are looking at. A CPT Code (Current Procedural Terminology) is a five-digit code assigned to every service a healthcare professional may provide to a patient. Insurers use these codes to determine the amount of coverage they will give to the provider. Everyone uses the same codes for the same services to ensure consistency. When you compare your list of services on your medical bill to your EOB, the CPT codes should match identically.
Doing all of this will help you pay only for the services you actually used.
You will also find a series of numbers broken down into different categories.
- Charges: Amount the provider charged for each of the services you received
- Allowed Amount (Adjustments): The rate negotiated by your insurance carrier (or possibly you) for a particular service. NOTE: In most cases you will not be responsible for the difference in prices between this and charges.
- Amount Owed (Patient Due): The remaining amount of money that you must pay for the services received. NOTE: In some cases, you may see additional charges on an EOB for existing services that need to be paid. These may not be broken down by individual services, but rather a date and an amount that are carried over and added to your new EOB.
Do you have questions? Let us know by calling 855-633-TRIG (8744) or e-mailing firstname.lastname@example.org.