Buzz
Medical billing errors are widespread, as we've discussed. One effective way to spot a mistake is to compare the charges on your bill with your health insurance Explanation of Benefits (EOB).
An EOB is defined as “the insurance company’s written statement about a claim, showing what was paid and what the patient still owes,” according to HealthInsurance.org. It’s not a bill, but it explains what you’re still responsible for paying out-of-pocket. Your insurer must send you an EOB whenever a claim is made for your care.
This is helpful for identifying billing mistakes, as you can cross-check it with the bills from your doctor or healthcare provider. This way, you can confirm if you've been double-billed or charged for services you didn’t actually receive.
Things to Verify on Your Explanation of Benefits
When you receive your EOB, there are several key details to verify. HealthValues.org offers a helpful guide and example to follow:
1. First, check that your doctor’s name is listed correctly to avoid being overcharged. If the doctor is listed incorrectly as out-of-network or as a specialist when you saw a general practitioner, you could be paying more. According to HealthValues.org, “If you’ve seen multiple doctors, ensure the doctor listed on the EOB aligns with the actual date of your visit with them.”
2. Make sure the date of service matches the actual day you saw the doctor.
3. Next, review the Charges section. This reflects the total cost of your care. As HealthValues.org explains, “The ‘Allowed Amount’ represents what you actually owe after any discounts from your preferred provider, if your claim is for an in-network service.”
4. However, the amount listed in #3 might not be what you end up paying. Section #4 breaks down your financial responsibility, including co-pays, deductibles, and co-insurance. In the example, the patient owed $216.92 after the insurance discount, and the remaining $43.76 was the balance of their deductible.
After applying the deductible of $43.76, the remaining amount is $173.16 ($216.92 - $43.76). Since the patient’s co-insurance is 20 percent, they will owe $34.63, which is 20 percent of $173.16. Combining this with the deductible payment, the total amount the patient owes is $78.39.
Look for errors
An essential thing to verify on your EOB, as CNBC reports, is that “the discounted rate from your in-network provider should be the baseline for calculating any coinsurance or deductible you owe,” not the full charges listed in #3 above.
In the example above, the deductible is applied after the in-network discount of $113.08 is subtracted from your total bill of $330. Then the co-insurance is applied.
If you receive a bill from your doctor’s office that exceeds what’s listed on your EOB, “follow what the insurance company says,” advises CNBC.
Remember, your EOB might also contain errors. For instance, if your physical exam is supposed to be fully covered by your plan but you're still billed for it, you should contact your insurance provider.
