Medical Insurance can be confusing. Plan Allowances, Deductibles, Co-Pays, Write-offs – it can make your head spin! With my wife’s sinus surgery coming up next week, we are right in the middle of all the paperwork and billing. How does one keep it all straight?

The way I am doing it is by checking the E.O.B. – the Explanation oBenefits that our health insurer gives. The basic information included on an E.O.B. is:

  • Provider and Date of Service: did we actually go to that doctor on that day (it has happened to us in the past that we were getting billed by a doctor that we didn’t see!)
  • Provider’s Charge: this is what the doctor charged for you seeing them / procedure being done
  • Non-Billable: this is the write-off that the insurer “negotiates” with the provider
  • Plan Allowance: what your insurance allows for a particular procedure (therefore the non-billable to member part)
  • Your Deductible: depending on your health insurance plan, you will have a deductible to meet before the insurance kicks in.
  • Your Copay: some services, like prescription drugs or doctor office visits have a part you always pay regardless if you meet a certain deductible. For example, our copay is $20 for office visits – we will always pay that every time we go to a doctors office
  • Amount You Owe: this may be the bottom line that you need to pay (but not always!).
  • Remarks: this is where I check carefully. Sometimes something is entered wrong and the codes here can help you see or explain why something was denied, etc.

Right now we have used over $1000 of our $1500 individual deductible (my wife). So after a little more than $500 in expenses for her, our insurance will pick up everything but copays. Except that (there are always exceptions!), my place of work splits the deductible with us (kind of like a company partially self insuring themselves to save some money), so in reality we will be getting $250 back ($750 is 1/2 and we were at a $1000). The EOB let me know that. Confused yet? It’s enough to make your head swim.

But by checking my EOB I can save money. I have caught errors; for instance one time a billing code was entered wrong and that service was denied, but with the right code it was then approved. I have received bills from providers (doctors) where they were supposed to send it to health insurance first, but either through a mistake or hoping to get their money quicker, they billed me first. By checking my EOB’s, or in this case not finding one, I can tell them to send the bill to my insurance, which in turn paid the bill. If I would have just paid the doctor without checking, I may have never gotten the money back, or at least had a hard time getting it back!

The time part that checking EOB’s saves me is that everything is in one place. For us, I can go online and check all the claims that are coming in, see where the insurance company is in the process, etc. It helps keep me organized, and that always saves time and money!

Categories: General