Understanding Your EOB

Navigating through the world of medical claims can be a bit cumbersome.  Often times, you or a loved one has just went through an injury or illness, and the bill is the last thing on your mind.  When the medical bills start to arrive, it can be a little overwhelming. Insurers and patients end up paying millions in overcharges each year that could have been avoided by carefully reviewing medical bills and insurance documents.  This is why understanding your Explanation of Benefits, or more commonly called an EOB, is a great benefit to you.

When a medical claim is submitted to your insurance company, they will process the claim and then send you an EOB with detailed information about what was billed, if it was paid or denied, and the percentage at which they paid.  While the EOB itself may look like a bill, it is actually not and holds a great amount of beneficial information for you.  Be sure to check the following information to ensure your medical bill was processed in the correct manner.

Every procedure you have done, whether it is at your doctor’s office or a hospital will have a specific procedure code.  These codes will also be found on your itemized bill from the hospital or doctor.  First, start by looking at each procedures that were billed and be sure that you actually had that procedure done.  Compare the itemized bill to your EOB to ensure they have the same procedures and codes listed.  While a lot of the billing systems are computerized now, there are still humans who are clicking the procedure codes.  We are all human and mistakes, and this could be the case on your EOB.  A simple wrong click could be costing you a great deal of extra money.

Next, be sure that you have not been double charged for anything.  Often times, procedures will be bundled together in one billing code.  However, sometimes the same procedure will also be added individually.  Check to be sure that each procedure is only listed once, whether it be in the bundled code or separately.  

Finally, check the percentages and the amounts that were paid.  The copay, deductible, and coinsurance will each be listed individually.  Be sure they have all been paid at the same rate that was explained in your insurance policy.  

While at first glance EOBs and medical bills can be overwhelming, overall they are a great resource for you to use to ensure you have been billed correctly.  Carefully reviewing these each time may end up saving you money.  If you are still not sure after reviewing your medical bill and EOB, do not hesitate to call.  It is better to be safe than sorry!

Click Here for an In-Depth Explanation on  How to Read Your Explanation of Benefits