As part of the U.S’s Health Insurance Portability and Accountability Act of 1996 (HIPAA), health insurance companies now submit a standardized form for all medical services and products billed under a health plan. This form is called an Estimation of Benefits (EOB), or less commonly a Remittance Advice (RA; these are the EOBs sent to your physician’s office) or Explanation of Medicare Benefits (EMOB). Your Estimation of Benefits is the primary tool for tracking and disputing what is paid out-of-pocket for your medical care. Trusting that your insurance company is billing accurately is a mistake that can cost you money. Billing errors and miscommunication regarding your medical care are common, and can adversely affect how much you are deemed responsible to pay.
Understanding the Basics
The first step in checking that your insurance company and medical providers are billing you properly is knowing the details of your insurance plan. Important info to look up includes:
- Copay amounts for different types of services (Urgent Care, physician’s office, outpatient services)
- Which facilities and medical providers are considered in network for your health plan
- What portion of services your insurance plan pays- usually expressed as a percentage
- Any excluded or non-covered services or medical items
- Expected amount of coinsurance payments
- The listed maximum out-of-pocket limit
Once you know how your insurance plan works and what is and isn’t covered, you’re ready to start looking at your Estimation of Benefits files. You should keep these files for a minimum of five years, in case there is ever a dispute about services rendered or paid to a provider.
Tips for Using Your EOB
Your EOB sheet provides vital information about what the insurance company’s records show regarding any healthcare services rendered to a party listed under your health insurance ID number.
Here, you can find the name of the patient, the date of service, the healthcare provider requesting payment, and your insurance company’s plan to pay a portion or all of the submitted charges. You will also find special codes that provide ID numbers for the patient and provider, reasons for denial of a payment, and diagnosis or service codes submitted on your behalf by the physician (CPT codes, or CPT modifiers).
One of the best ways to track this information, especially if you visit the doctor often, is to scan the EOB and feed the info into a spreadsheet. This method allows you to sort the info by date of service, provider, or any other parameter listed on the EOB. This also makes submitting your out of pocket medical costs for tax purposes much easier at the end of the year. However, this method can be laborious at times and is not for everyone.
For those who prefer a simpler method of tracking, you can keep two files. One filled with original EOBs sorted by date received, and a second working file filled with copies of each EOB sorted in any manner that works for you. On the copied EOB pages, you can highlight important info or suspicious charges, and make notes of any contact with your medical provider or insurance company. Be sure to list the date and time of the contact, the first and last name of the person you spoke with, and full details of what was discussed. Having exact details when disputing a charge will go a long ways toward getting the issue straightened out with the least amount of hassle.
If you have an EOB tracking or filing system that is working for you, we want to hear about it! Your system can help others become more efficient in tracking healthcare charges. Feel free to share your tips in the comments section below.
Next week, we’ll cover how to read the information on your EOB, including how to make sense of all those codes.