Many times we hear individuals say they receive correspondence from their health insurance carrier that has large print stating “This is not a Bill” believing the document is not important and dispose of it. In fact, this correspondence received from the health insurance carrier is the explanation of benefits statement that explains how a claim, or claims, was processed for services received from a healthcare provider and indeed is very important to keep.
The explanations of benefits, or EOB, you receive from your health insurance carrier is very important and should be kept with your medical paperwork. These statements explain who the provider of service was, the date the service was rendered, what type of service was given, the amount charged, the amount approved, the amount paid and what the patient responsibility may be. The EOB also explains how much of the annual deductible has been met as well as the amount of the annual out of pocket maximum that has been applied for the year.
Keeping your EOBs is important for many reasons; let us explain a few of these. One reason is that once you receive a billing statement from your doctor or hospital, you have the EOB to use as a reference to verify that the balance being billed is correct. If the balance differs, you can contact the provider’s billing office and explain what the amount the health insurance carrier stated you were responsible for; the billing office may ask you to fax a copy of your EOB to them. Another reason is that the EOBs include remark codes that explain many things such as why a procedure may have been denied. You can use this information to appeal the claim for a reversal of the original denial. Finally, by reviewing your EOBs, you are able to be a “watch dog” so to speak for the health insurance carrier. If you receive a statement for services you never received, you can contact the health insurance company so they can review and research what was sent to them; in turn, this may help save the company money.
You may ask why the health insurance carrier prints “This is not a Bill” on their statements. Because the EOBs can look similar to a billing statement and does may times state patient responsibility, the health insurance company prints this on their correspondence so the policy holder does not send money directly to them. The healthcare provider will also receive an EOB from the health insurance company as well indicating how the claim was processed and what amount the patient may be responsible for.
For us, these documents are very important in managing our clients’ medical paperwork and we stress the importance of mailing them to our office. Without them, we would not be able to inform our clients what to pay, how much of their deductible has been met or assist with filing appeals. So even though the bold print reads “This is not a Bill”, these documents are very important to keep.
If you have any questions about the EOBs you receive or are confused as to what information they contain, please give our office a call to speak to one of our knowledgeable staff.