If you have health insurance and have been to the doctor, you've received something called an EOB (explanation of benefits) from your insurance company. People often receive an EOB in the mail a few weeks after a doctor visit, and can be confused about its purpose and read it.
Reviewing your EOBs can keep you from paying too much for doctor or hospital charges. There are some helpful things to know about reading and using an EOB.
Instructions
Know the various parts of an EOB
1. Understand your EOB, which explains the charges and discounts for each of your insurance claims. It is not a bill. The EOB outlines the charges for your visit and spells out any co-pay or co-insurance you owe, the amount you may have paid toward your deductible and your network discounts.
2. Look for a separate EOB for each charge. If you only went to the doctor for a visit, you'll get one EOB for that visit. However, if you saw the doctor and also had lab tests done, you may receive a second EOB if the tests were sent out to another location to be read. If you had a hospital stay, you will receive EOBs for several services such as doctors, pathologists, labs and the hospital.
3. Review the claim charge. This is the initial charge that your doctor and hospital makes for the service provided. You should never pay this amount if you have insurance, because this claim will always have discounts and other benefits applied to it before the final amount you owe.
4. Take note of any provider or network discount. One of the benefits of having insurance is that you will receive network discounts off the initial charge, most often 10 to 50 percent. For example, you saw your doctor, who is considered in-network, according to your insurance plan. If your doctor charged $120 for the visit and it was discounted $52, your responsibility would be $68.
Wait. Your amount will still have co-pays or co-insurance applied to it.
5. Check the co-pay. Depending on your plan, you may make a co-pay for visits. If you've ever visited the doctor and paid $20 at the office and didn't pay anything else afterward, that's a co-pay. Co-pays vary by plan, and they are often listed on your insurance ID card. What this means is that your doctor receives $20 from you and the remaining amount is paid to your doctor by your insurance plan.
If you take care of the co-pay at your visit, keep a receipt of it. This way, you will not overpay if your doctor accidentally bills you again for the same co-pay.
6. Check the co-insurance. Most plans have either a co-pay or co-insurance. Co-insurance is calculated as a percentage of the bill after the discount is applied. There is always an in-network and out-of-network co-insurance amount. Since the in-network amount is always far less, you should make every effort to see doctors within your insurance plan's network.
7. Make sure the deductible was applied. Most plans have some sort of a deductible. This is money that you must pay out of your pocket before the insurance plan will start paying the charges. Your EOB should explain (possibly on the back of the EOB) how much of your deductible you've paid and how much you still owe. Keep in mind that some plans still require you to pay co-insurance after you've met your deductible.
8. Find out what you will pay. Don't pay anything until you receive a bill from your doctor or hospital. The best method for making sure you are paying the correct amount is to compare the bill with the EOB. What you are being charged by your doctor should match the amount the EOB says you owe.
Tags: your doctor, your insurance, insurance plan, doctor hospital, your deductible, your insurance plan
