Understanding Your Medical Bills
“Some have abbreviations and scientific terms that you need a medical dictionary or a graduate degree to comprehend. Some have no information at all,” says the The New York Times. Before you pay, you must know the basics of medical bills. Here’s the breakdown:
Billing Statement vs. EOB
The hospital, clinic, or doctor’s office bills your insurance company for medical services. Some medical service providers might send you a statement, which shows the amount billed to your insurance company. You are not responsible for paying amounts listed before your insurance company pays the doctor. After your insurance company receives the bill, they might send you an EOB- explanation of benefits, which explains the amount covered by your health benefits and its contract with the medical services provider. According to Nerd Wallet, “the EOB is meant to be a tool to explain why you’re responsible for the remaining costs and where you’re at with your deductible.” EOB statements are not a bill.
You may need to pay the doctor the balance of the medical bills, known as “patient liability.” Sometimes, the doctor’s office will send you a billing statement requesting the balance. But, it’s important to know that not all doctor’s offices send medical bills. Some providers will only provide an itemized bill if services total $10,000 or more, says Nerd Wallet. However, you should always request itemized medical bills. That way you can compare the bill to the EOB from your insurance company.
Analyzing Your Medical Bills
Once you have both the billing statement and EOB, it’s important to review them. Especially since billing errors are common. “Nearly eight in 10 medical bills contain some sort of error, according to Medical Billing Advocates of America,” as noted in U.S. News & World Report. “Though accidents happen, sometimes health care facilities incorrectly bill your health insurance company or Medicare.”
Start by checking general information, including the dates of service and description. If they don’t match, call your doctor’s office or the hospital that provided the services.
Then, review the billing codes – called CPT, short for Current Procedural Terminology – on both documents. To learn what the codes mean, visit American Medical Association’s CodeManager. But it’s not necessary to understand the codes to analyze your medical bills. Simply make sure they match and look out for duplicates. Some may be correct if a procedure was performed more than twice. Others might have already been rejected by your insurance company. Find out why. You should also review your EOB for charges your insurance didn’t pay for to ensure you received those services and they don’t look similar to paid charges.
If it’s been more than 60 days and your medical bills haven’t been paid by your insurer – or you still have questions about your health benefits coverage, contact your insurance company. If you’re still unclear about what you owe, look at the bottom of your final medical bills for the “balance” or “patient responsibility.” This is typically the true balance for your medical services minus anything you’ve already paid, including a co-pay, deductible, or credit. If you need help, hire a medical billing advocate.
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