I check my insurer's explanation of benefits each time they arrive, but they tend to confuse me. I need to know the best and easiest way to check the explanations in case of future errors or disputes. - Charlotte Confused
Dear Ms. Confused: As mentioned in a recent column, I've been busy lately with presentations centered on protection from identity thieves. Unfortunately, you having a problem reading your EOB (Explanation of Benefits) to ensure your insurance claims are correct is, by far, the least of your worries; ID thieves love to get their greedy grasping fingers on our medical information, which is the gateway to comprehensive and, possibly, everlasting fraud. So let's see what we should do in order to decipher the statements while they're still above suspicion, compliments of consumer.ftc.gov.
1. First off, make sure you actually obtain an EOB for each provider's visit. Both this statement and the provider's bill should match the following: the amount charged for the visit or procedure; the amount your insurer is paying; and the balance you owe, if any. If the amounts for both documents don't agree, get out your dialing finger and get to the bottom of what's going on.
2. Acquire an itemized list of services. For example, rather than being billed for "lab work," be certain you know exactly which labs and for what condition(s). Obviously, an itemization makes errors lots easier to spot (and, believe you me, if we're talking about a hospitalization, even an itemized list can still run several pages.). If you do undergo a surgical procedure that totals from a few to many thousands of dollars, it's always best to ask for the itemization upfront. Should you forget, call the provider and/or hospital's billing department ASAP to request a complete, separate listing for the amounts the insurance company says you owe. Do not pay a single penny until you have this info in hand. Moreover, it's good to remember that a bill and an insurance payment may cross in the mail. A perfect example is a $29.04 bill I received a few days ago from an anesthesiologist. In checking the statement (which I always do), I noticed my secondary insurer had paid zippo toward the bill. Quite frankly, some people simply would have paid the twenty-nine bucks, a fairly insignificant amount. I called the billing department and discovered my secondary paid the $29.04 just two days after the provider mailed to me the "balance" owed.
3. Codes are very important. Look for current procedural terminology (CPT), used by physicians to categorize treatments and procedures, and found on your EOB. Unless run-of-the-mill patients possess medical jargon knowledge, it's best to google the codes to identify their meaning so your eyes and brain can collaborate.
Lastly, and, in my opinion, perhaps the most important reason to always thoroughly check our EOBs is to avoid medical identity theft. Keep an eagle eye out for a bill for medical services you didn't receive, a call from a debt collector about a medical debt you don't recognize or owe, a notice from your health plan saying you reached your benefit limit, or a denial of insurance because your medical records show a condition you don't have. Be safer than sorrier or just plain 'ole paranoid like I am. The person idling behind you may be an innocent bystander or a not-so-innocent using his smartphone to video or photograph your insurance card or, even, "overhear" (i.e. deliberately eavesdrop?) a confidential conversation with your insurance company. Please don't forget a column in which I discussed the terrible - and ofttimes permanent - financial straits in which we may find ourselves once a Scummy Scammer Starts Skimming Specific Secrets. (Alliteration sometimes says it best, doesn't it?)
Perhaps I should have conserved this particular column for last week rather than this week before Halloween; way too much nasty tricking going on these days to suit me