It’s important to be able to understand your medical bill. If you don’t, you could end up paying more than you need to.
But that’s easier said than done, since reading a medical bill can feel like reading a page of Greek – it just doesn’t make sense!
The insurance carriers have tried to ease your pain by providing an explanation of benefits (EOB); however, reading this document can leave you just as confused as the medical bill.
Learn the process
When you visit the doctor or hospital or receive a medical service, that entity sends your insurance company a bill first. The insurance company takes a look at the bill, identifies the portion of the charges it owes, and then they send you the explanation of benefits. Simultaneously, your insurance carrier will also send you a bill for payment owed. You will usually receive the EOB first.
Comparing the two
Your medical bill could contain simple errors, like a name misspelling, that will cause your insurance carrier to reject your claim. Or a simple billing error that you don’t catch could mean having to pay more than you really owe.
To discover billing errors, here’s what you need to do:
- When you open the bill, make sure it’s itemized. Don’t pay a bill that shows a lump sum payment that’s due. You’ll want to be able to review each item that you’re being billed for so you can compare the services to the explanation of benefits.
- Check that the information on the bill is correct, such as your name, address, date of service, etc.
- With the itemized bill in hand, start comparing it to the EOB. Check each charge against the codes listed on the EOB.
- Look for errors. Review the charges that the insurance isn’t paying. Can you find a line item charge for a service that you didn’t actually receive? Do you see marked similarities between the charges the carrier has paid and the charges you still owe? For example, it’s commonplace for a carrier to bundle charges together, but it’s also a common error to charge for services in a bundled fashion, and then also list each of the bundled services as separate charges. It’s your job to identify this kind of error.
If you don’t find any errors, you can go ahead and pay the bill.
If you’re unsure about the bill, you should get help. You can always ask the doctor’s office or hospital for help understanding your bill and the changes, or work with a healthcare advocate.
Nonprofit organizations exist to help individuals figure out their medical bills, or you could ask a friend or family member to help you work through the bill. It’s also possible to hire a professional health advocate. However, these individuals will charge for the service.
Make sure you understand your medical bill and don’t pay it until you’ve worked through every line item and are confident it’s accurate. If you’re taking your time to review the bill, be sure to call the insurance company or service provider to let them know you are working things out and in order to avoid late fee charges.
For help with an insurance policy review or identifying a policy that will cover the procedures and medications you need, work with the InsureOne Benefits team.