ConsumerWatch: Learn to understand explanation of benefits

ConsumerWatch: Learn to understand explanation of benefits

May 19th, 2012 in Business Ellen Phillips

Ellen Phillips

Q. I stay confused about my EOBs (Explanation of Benefits) from Medicare and the like. Can you tell me an easier way to decipher these forms? - Ned Needy

Dear Mr. Needy: You're right - sometimes EOBs are very confusing. But Bottom Line Personal has the right approach to read them with no problems.

• Every EOB must have the insured's name, the patient's name and insurance ID number, plus the name of the doctor or hospital that submitted the claim to the insurance company. Carefully eyeball "Total Charges" and "Allowable Amount." The latter is the sum the doctor/practice has agreed to accept as full payment.

Moreover, it's obviously important you check the columns under "Patient Responsibility;" this explains what you have to pay as part of your deductible or copayment. If the provider tells you to pay more than what your policy requires (usually 20 percent), then call the insurance company ASAP and do not pay any further amount until the situation is corrected.

• Anther common mistake other than overcharging includes mixing up patients with similar names. Be sure you study the EOB to ensure you haven't been overcharged in the first place and that you're not being billed in duplicate. As I always urge, it's imperative to have an itemized list of services provided to begin with so you can avoid many of these errors upfront.

• And last but not least, check to see that the EOB belongs to you. Seriously.

Ellen Phillips is a retired English teacher who has written two consumer-oriented books. Her Consumer Watch column appears every Saturday. Email her at consumer watch@timesfree