Wait for the EOB
EOB stands for Explanation of Benefits.
It’s the form from your insurance company that shows how much your healthcare provider was reimbursed for your office visit, lab work, x-rays, etc.
Typically it arrives at your house before the individual bills from the provider, which show the balance owing, or what you are expected to pay.
Keep this in mind: Don’t pay a medical bill until you’ve compared the services and charges to your EOB!
Insurance claims can be wrong
A few months ago my husband had his annual physical. About a week before his visit, he had blood drawn for his routine labs. He likes to schedule it this way because then the test results are available at his physical, and he and his doctor can review them face-to-face.
Related post: Question “routine” labs
As usual, he coordinated this with his physician’s office staff.
Well, a couple weeks after his visit the EOB arrived in the mail. Because I’m in charge of all things health related in our family, I went ahead and opened it.
I immediately knew something was wrong. Most of his blood tests should have been covered at no charge as part of his preventive exam. Instead, the EOB showed us owing a balance of almost $200!
I called our insurance company’s customer service and was told the all-important billing codes were wrong. Most likely the doctor’s office staff hadn’t reported them correctly when ordering my husband’s tests.
Then I called the physician’s billing office, but was told they couldn’t do anything about it. My husband would have to contact his doctor directly and ask him to resubmit the charges with the correct codes.
Or as she helpfully put it, “Well…you could try asking his doctor…otherwise, I guess you’ll just have to chalk it up to experience so it doesn’t happen again.”
Not good enough. This was not our fault.
We hated to bother his doctor with this type of paperwork, but it was the principle of it all—and $200!
So my husband contacted his doctor, who was also not very hopeful. He really wasn’t sure which tests would be covered by the preventive care benefit. Still, he agreed to resubmit the claim.
Don’t pay before you get the EOB!
Then my husband confessed to me that the bill from the lab had already arrived and he had already paid it. He thought he was saving me time by just taking care of it himself.
This added another wrinkle to the situation. We not only had to get the claim resubmitted and reviewed, but if the insurance company changed the EOB in our favor, we would have to make sure we were reimbursed what we had already paid.
As I write this post, I just received the new EOB showing that we owe $0.00. However, we still haven’t been reimbursed, so will have to take more time to follow through on this in the upcoming weeks.
A lot of time could have been saved if my husband (bless his heart for wanting to save me some trouble) had just waited until the EOB arrived in the mail! I teased him that Mr. Frugal Nurse should know better by now 😘
If you find yourself in a similar predicament, don’t be put off by your insurance company or provider’s apathetic response. It is your provider’s responsibility to code the claims properly, so hold their feet to the fire even if it takes some time and effort on your part.
Of course, the best case would be to double check for the correct codes before any healthcare service.
It’s not always possible, I know, and EOBs can be incredibly lengthy for surgeries and hospitalizations. Still, check each line item as carefully as you can and flag any charge you think is a mistake or you don’t understand.
It’s too bad that these details fall to the patient now, but that’s just the way it is.
Buyer (patient) beware!