Friday, August 17, 2012

Why You Should Always Keep Your Health Care Explanation of Benefits

Have you ever wondered why your health insurance provider sends you something called an Explanation of Benefits (a.k.a. EOB) in the mail after a doctor visit or medical procedure?  To do just that...explain what the insurance company will pay for (your benefits) and what you, as a subscriber, are responsible for.  

I have learned over the year to keep all of these EOB's, even though I want to throw them out as soon as I get them.  Why do I find it important to keep these EOB's?  Yesterday, I had an experience that was a perfect case in point.

I received in the mail a bill from my doctor's office 2 months after my visit.  Some offices can be this delayed in their billing process, but since I had already received another bill a month ago, I thought this was kind of fishy.  So, using the date of service on the bill I received yesterday,  I cross-referenced the same date on my Explanation of Benefits document and found that my insurance company did not pay for the service on this new bill.  However, the EOB also indicated that I was responsible for $0.  Now, I was fairly perplexed and decided to call my health insurance provider. 

The health insurance customer service agent was very kind in looking into my situation.  As she found through all the coding and service descriptions that were provided, my doctor's office billed the insurance for the same service twice, and, of course, they certainly weren't going to pay for it twice.  But as she explained, I didn't have to pay for it out of my pocket either. 

Now, I was prepared to call the billing department for my doctor's office.  I explained to the billing representative the history of the situation, and sure enough, he conceded that they had billed my insurance twice, and when the insurance didn't pay for it, they billed me.  The billing representative immediately removed the charge from my account which left me with a $0 balance. It was that simple.

But here is my thought/question: How many people would get the bill and just pay it?  I mean, I did have that service provided to me, so maybe I am responsible for that additional cost, right?  With the hassle of having to call the insurance company and billing department, some people might just say that it isn't worth their time and just pay the bill.  And I might have done the same thing, too, if I didn't have my EOB to verify for what I am responsible to pay. 

This is just another example of how we, as patients, have to be our own advocates. We have to ask the right questions to proactively stay in good health plus we have to stay on top of our health care plans and providers to make sure we are getting what we sign up/pay for and certainly not paying for something we didn't get. 

Basically, you have to be your own watchdog...woof, woof!

Happy Friday!

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