Any time I’m paying a medical bill, I’m pretty much always thinking one thing: Is this how much I really owe?
Unless it is a nice straight-forward co-pay, it’s pretty near impossible to be sure a bill was calculated correctly. That’s why it’s so important to compare the statements your insurance sends (EOBs) and the statements your provider sends (the bills).
First, let’s make sure we’re clear on the difference between these two!
Check it out here.
With a good understanding of the difference, we can dig into why it matters – and how you can be your own billing advocate. It’s not easy (or fun) but you’ll be glad you know the two worlds and how they interact if you’re able to keep from over-paying a bill.
Here are some reasons to compare the statements.
1) Providers may bill you with outdated information.
Doctors are only supposed to bill you after your insurance has processed a claim. But insurers are well, pretty slow at paying out claims sometimes. Many providers will continue to send out statements without knowing that an additional payment is on it’s way from an insurer. Claims are adjusted all the time, so if you find a bill doesn’t match an EOB, you may want to find out if an adjustment was made before paying.
2) EOBs won’t always show payments you’ve already made.
If you made a payment before a service, it may not be reflected in your EOB, since EOBs are just calculations of what you “may” owe. Your insurance company may not know how much you actually paid your provider already.
3) Your deductible responsibility may change.
Earlier this year, I received two unrelated health services, within the same week. The first service ended up putting me over my deductible – hooray! But when the provider billed me for the second service, this information hadn’t hit the insurance company’s system yet, and I overpaid towards the deductible. If I had waited for an EOB before paying, I might have avoided this.
The general advice?
Neither EOBs or bills alone are the truth. Health insurance has a lot of moving parts and tons of payers and providers all on different billing and payment cycles. Most of the time, the statements match each other pretty well, but it often takes comparing the two and drilling into the information to make sure you’re paying the right amount.