Is an EOB the Same as A Medical Bill?
If you’ve recently used your health insurance for a doctor appointment or a visit to our ER, you may have already received an EOB (Explanation of Benefits) from your insurance company.
Many patients get confused by what an EOB is, what they need to do about it and if it’s the same as a medical invoice.
This article aims to clarify a lot of these questions.
What Exactly is an EOB?
The EOB is a statement of charges created by your insurance company after you’ve filed a claim to cover some or all your medical expenses.
The information contained in an EOB varies from one insurance company to another, as there is no standardized form, yet all Explanation of Benefits will include the following:
- Details concerning the services you received from the healthcare provider
- The charges for those services
- How the charges were processed by your insurance company.
Although the EOB will contain a section detailing the amount you owe, it is not a medical bill, and therefore you don’t need to make any payments when you receive it.
TIP #1. DON’T PANIC. AN EOB IS NOT A BILL.
What is a Medical Bill?
The EOB is a statement from your insurance company, a medical bill, on the other hand, is a statement created by your healthcare provider for the amount owed from the services you received.
It can take more than 30 days for you to receive a bill from your doctor, hospital, or ER, this is due to processing times, and whether the provider had to send documentation or appeal to the insurance carrier.
A medical invoice will include the following:
- Any payments made by you at the time of service
- How much your insurance company paid
- How much you owe
The amount owed in the medical bill should match the one stated on your EOB, never pay more than what the medical bill indicates.
TIP #2. ASK QUESTIONS. CALL THE ER IF YOU GET ONE.
What You Need to Do When You Get an EOB.
Now that you know the difference between these two types of statements the question remains, what should you do when you get an EOB.
The EOB is sent to you so you can check that the claim that was filed on your behalf accurately reflects the services you received.
Therefore, when you receive it you should check the following information:
- Personal Information: Your name, address, and other personal information should match yours, if it doesn’t, it could be a simple mistake, but it could also be a case of insurance fraud. If you suspect the latter contact your insurance company and the authorities.
- Services Charged Were in Fact Provided: Insurance claims contain medical codes known as Current Procedural Terminology (CPT) to identify the procedures and a typo could mean you are billed for something you did not get. If your EOB contains more than one claim, double check to ensure you are not being charged twice for the same service.
- Corroborate the Benefits Coverage: It’s always a good idea to refer to the terms of your insurance plan to guarantee you are getting the full benefits coverage you are entitled to. Keep in mind that any deductible, co-pay, or coinsurance is factored into the EOB.
A lot of patients feel it is not necessary to keep the EOB as it is not an actual invoice; however, this is not the case.
TIP #3. DO NOT THROW IT AWAY.
An EOB is an essential record of claims for any medical services and benefits coverage, because of this it’s advisable to keep them for at least 18 months and preferably 2 years just in case any questions or disputes arising from your claim or medical bill.
What If Your Insurance Company Doesn’t Pay Your Claim?
There are many reasons why a claim might be denied, or why an insurance company doesn’t cover the amount you think it should.
When you check your EOB, if you find the amount you owe is higher than you expected, contact your insurance agent right away to find out why in some cases our billing department might be able to help.
As we mentioned before, insurance claims utilize CPT codes to identify the different services, some services may not be covered by your plan, but similar ones are. If this is the case, please contact our Patient Advocate Department to see if there is a similar code that is covered by your health care plan; if there is, they will gladly make the correction and resubmit the claim.
TIP #4. IF YOU ARE DENIED, WE CAN HELP.
The Patient Advocate Department at Prestige ER is always available to help you understand the claims procedure and to ensure you always receive the full benefits covered by your insurance plans. Our Patient Advocate Staff will also file claims on your behalf, follow up with the doctors and insurance companies, as well as submit appeals in case your claim is denied.
If you have any questions regarding a bill, please don’t hesitate to contact us, and if your appeal was denied and you need assistance with your payment, know that at Prestige ER we can help work out a payment plan that adjusts to your budget.
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