What is an EOB? Well, that’s a great place to start our Daily Dose of Thrifty. After you or your family member visits your doctor, the medical office will send a medical claim to your insurance company. The response that your insurance company provides you regarding the claim is called an Explanation of Benefits (EOB) which explains what was covered by your plan, how much was paid, and ultimately (what you really care about) how much you owe.
Why do you need to understand an EOB? Because for some reason, at least in our experience, either one of two things usually happen (or at least more often than your doctor’s office or insurance company would like to admit).
- Your doctor’s medical office may bill the insurance company incorrectly. This means that something that should be covered sometimes won’t be. I would highly recommend checking every claim, but especially during a checkup that you expect to be paid at 100%. We have found a few times that vaccinations are often billed incorrectly – meaning that a checkup that should have been free (at least in our case) has a remaining balance.
- You may think it odd, but the insurance company isn’t always very good at paying the right amount – which means that someone gets to pay more. I’ll give you a hint that its not your insurance company and definitely not the doctor’s office. If you guessed “YOU” then you’re usually right. 🙂 Just today (after a few appeals) our insurance company finally realized that an emergency room visit at an in-network hospital should have left me paying only in-network balances – I won’t get into the complexities, but finding that “small” detail saved us almost $200 in our coinsurance for this one claim.
You may not understand everything that’s mentioned about coinsurance, deductible, medical claims, and EOBs, but I would highly recommend you start to figure it out. In the first years of our marriage I remember never checking a single EOB – the doctor’s office and insurance company must have processed everything correctly. Right? And it was much too difficult for me to take the time to figure out. Wrong!
Here’s a few hints for starting to understand your insurance a bit more.
- Try to actually understand what your health care plan covers – Ask yourself what kind of care is provided for preventative care. Check to see how much your deductible is and how much is left. Find out the difference in payment between in-network and out-of-network providers.
- Make sure your doctor or hospital is covered in-network – Unfortunately sometimes the problem will be on your side. Maybe you’ll visit a hospital that was in-network last year and is out-of-network this year. Yep, we’ve had hospitals change like that. Sometimes the office will let you know that your insurance will only cover so much of the bill, but at the end of the day its up to you to make sure.
- Do the math – This is more difficult at first but becomes much easier as time goes on. Can you add up the different responsibilities (how much was paid by insurance and how much you owe)? Can you do the math to understand whether something that was supposed to be paid at 80% really was? Understanding these numbers will help you start noticing errors.
- Ask yourself if something doesn’t look right – As time goes on you might notice many of the claims will be similar. But when you get that one claim that isn’t paid the same way as the others ask yourself why. Did you really go to an out-of-network provider when you knew for sure you double checked that before you went?
- Ask your doctor for what they expect your portion to be – This won’t be 100% accurate all the time, but asking to be provided an estimate of your total portion after the service will give you a place to start in understanding your health insurance. Especially if the visit is for more than a normal visit (e.g., surgery, allergy treatment) it will be useful for you to know how much is covered before you are treated.
Using these hints will help you understand that black box of health benefits. Hopefully they will start saving you hundreds each year (we have currently saved over $250 just this year along by using these tips). Once you start cracking that box open and look inside you’ll wish you had sooner. Do you have any tips that you would like to share? We would hearing your tips and suggestions as well!
Leave a Reply