However, if you have a Medicare Part D plan orMedicare Advantagecoverage, they will send EOBs.)
But your EOB is a window into your medical billing history.
Practitioners offices, hospitals, and medical billing companies sometimes make billing errors.
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Such mistakes can have annoying and potentially serious, long-term financial consequences.
An EOB can also be a clue tomedical billing fraud.
Your insurance company may be paying for services billed on your behalf that you did not receive.
Her PCP sent the X-ray to a radiologist to be read.
The following month Mary got her EOB and a bill from the radiologist.
In this case, Mary’s PCP’s office might catch the mistake and delete the billed amount.
In some cases, patients are responsible for charges that the insurer doesn’t cover.
Miscalculating Your Coinsurance Amount
Robert M. had outpatient surgery on his hand.
Wrong Diagnosis or Procedure
Zahara D. went to her PCP for a sore throat.
Her healthcare provider resubmitted the claim with the correct code and the insurer reprocessed it.
But a few weeks later, she got a bill from the doctor’s office for several hundred dollars.
She contacted her health plan, notified them of the error, and asked them to reprocess the claim.
He is enrolled inOriginal Medicareand visits his healthcare provider two to three times a year.
Jerry called his healthcare providers office to confirm that his practitioner had not wrongly billed for another patient.
Jerry shared his paperwork with the local Medicare office.
Switching Health Plans
Martha S. recently changed jobs and had to change health plans.
Along with her office visit, Martha also had some blood tests.
Martha noticed that the EOB was not from her new health plan.
Every time a provider submits a claim on your behalf, your insurance company must send you an EOB.
Unlike EOBs from private insurers, MSNs are not sent after every claim.)
When You Get Your EOB
Check to double-check the dates and services you received are correct.
Watch out for possible billing fraud or medical identity theft.
Read the remarks or code descriptions at the bottom or the back of your EOB.
EOBs tend to be quite accurate, but there can sometimes be errors.
They can result from a mistake made by the medical billing office or by the health plan.
Along the way, the humans and computers involved in the process can make mistakes.
Centers for Medicare & Medicaid Services.How to read an explanation of benefits (EOB).
Employee Benefits Security Administration.Internal claims and appeals and external review.
