Articles by: The Simplee Team

Posts By: The Simplee Team


How to Use Your EOBs & Bills to Lower Your Costs

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1) Providers may bill you with outdated information.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.

Good luck!



4 Things to Know about Statements & Medical Bills (to Keep from Overpaying)

If you ever received a medical service and used your insurance, you have surely received a lot of paper in the mail or electronically. Do you know the difference between all of them? The most important distinction is between Explanation of Benefits (EOBs) and statements from your provider. Why? One is a true bill, one is not.

So what’s the difference? An Explanation of Benefits (EOB) is your insurance company’s way of informing you that they know you’re covered, they looked at the claim your provider sent them, and here’s how much they calculate you’ll owe. It’s an FYI.

At the same time, your insurer sends this information back to your medical provider – along with their payment to them. Then, it’s your provider’s turn to take that info and – voila! -put together a bill for you.

Now that you’ve got the sequence of events, that means a few things for you:

1) An EOB is only an FYI. To be certain about the amount you owe, wait for a bill from your provider to verify the amount.

2) EOBs usually arrive before a bill. So when you see a new EOB, you now have a sense of what to expect. If you receive a bill before you get an EOB, check to make sure your insurance paid and you aren’t getting billed for the full amount.

3) At the end of the day, your provider is who you owe. Don’t send money to your insurance company for an EOB!

4) You could owe less. Your provider may further adjust the amount you owe with additional discounts, but you should never pay more than the EOB shows. Your provider cannot bill you for something the insurance company did not pay if it wasn’t described as your responsibility in your EOB.



5 Ways to Better Manage a High Deductible

So you’ve got a health plan with a (gulp) high deductible. That’s pretty common these days, so you’re not alone. In fact, a good chunk of the plans sold on the insurance exchanges are high deductible health plans (HDHPs).

High deductible plans are great because they cost less when it comes to the monthly premium. But you need to be prepared for when, or if, the bills start coming in.

Here are five things you can do now to make managing your deductible easier.

1)  Save save save

One of the worst things you can do if you have a HDHP is to go without savings sufficient to cover your deductible. This is why all HDHPs come paired with a Health Savings Account option. HSAs let you save money tax-free. If you’re going to save for medical expenses anyway, why not get a break on taxes too? If your health plan is through your employer, they may already be making contributions to your HSA. In addition, you might also consider putting in your  own monthly contribution, as most employers only contribute enough to fund the full deductible over the course of an entire year. If you want the savings to build up faster, you’ll need to kick in some funds yourself.

2) Know what’s excluded

Because of the Affordable Care Act, all health plans must provide preventive care free of cost. That means these services won’t count towards your deductible. It’s also common for plans to exclude certain co-pays or have a separate deductible for prescription drugs or for out-of-network providers. What you don’t want is to be in a situation where you thought you were fulfilling your deductible when you uhh, really weren’t.

3) Understand family deductibles

Do you have your spouse or children on your health plan? Each member of the family may have a separate deductible. To make things more confusing, there are no standard rules for how plans calculate these. Each individual member may just need to meet their deductible separately. Or it may be the case that one member of the family must meet the entire family deductible for coverage for everyone to start. Check with your health plan if you’re unsure.

4) Know the plan year

Most plans use the calendar year (January to January) for resetting deductibles. However some use a fiscal or academic year. Also keep in mind that the deductible year could be different from the rollover period for FSAs or HRAs for your plan.

5) Reevaluate if needed

HDHPs tend to work best for people who either don’t use a lot of health care or who, if they are sick, have a lot saved up. If you anticipate a lot of expenses year after year, you may find a lower deductible plan works better. Don’t be afraid to switch plans at your next opportunity if this feels like you–remember, you won’t lose any money left in your HSA if you choose to do this. HSA funds belong to you once they are in your account, regardless of if you change plans or employers.




In with the New, Out with the Old: A Quick Comparison of 2013 & 2014’s Health Plan Costs

It’s time to say good-bye to 2013’s insurance and hello to 2014.

How did you fare in 2013? Some new research from eHealth looked at the average amount that Americans paid towards health insurance this last year. We tried to compare this to the plans available in the insurance exchanges for 2014.

According to eHealth, in 2013, the average individual premium was $197 for a basic plan, and $247 for a comprehensive plan.

And the average annual deductible for an individual was $3,319.


So can you expect to do better or worse in 2014?

There aren’t a lot of solid numbers on the 2014 plans being offered on the exchanges. But even if there were, there are a couple things to keep in mind: For one thing, the plans being sold on the exchanges are generally better than those that were sold up until now: they must meet some minimum standards by covering a set of basic Essential Health Benefits. In addition, many people will be eligible for a tax subsidy, which will help offset their premium (you can calculate your subsidy here).

Some research found that the average premium for a health exchange plan is $328. But that doesn’t really tell us much when it’s averaged across all plans, in all geographies, and for all ages.

For example, for a 27-year-old, that plan would be $163 for a basic Bronze plan or $240 for more comprehensive Silver plan.

And across all states, the average premium for a pretty comprehensive Silver plan ranges from $192 to $516.

When it comes to deductibles, the plans on the exchanges range from an average deductible of $4,300 (for a Bronze plan) to $2,500 (for a Silver plan). Or if you wanted to get the best of plans (Platinum) your deductible could be as low as $167.


Well, that’s a lot of numbers. So what’s the moral for 2014?

We’d probably sum it up to say that some people may end up with more costly insurance. But most of them will probably enjoy having better coverage or even getting a subsidy on their premium. And either way, you’re likely to be amongst the crowd that has a high-deductible plan – this seems like a trend that isn’t going away soon.

Let us know how your 2014 is shaping up – and how Simplee can help you manage your costs in the New Year!




End of the Year Health Insurance Tips

What? It’s December already? It snuck up on us too. Here are a few things everyone should make sure to check out, check up on, or wrap up before the New Year starts.

New coverage

2014 marks the beginning of coverage via the health insurance exchanges. If you’re thinking about enrolling in a plan through the exchanges, December is the time. Even though the deadline to enroll has been extended to March 31, if you wait, your coverage won’t become effective until the month following when you enroll. For your coverage to begin in January, you’ll need to enroll and pay your first premium by December 15th.

Leftover annual benefits

Does your plan include benefits that expire at the end of the calendar year? This is common for preventive dental care and vision benefits. Make sure you’re not leaving anything out!

FSA or HRA balances

Do you have funds left in your FSA or HRA? You may lose any money that you have set aside but not yet spent. A new rule was just passed to allow employers or benefits administrators to roll over these funds, but it is only effective if your employer chooses to implement it (the rule is optional). Check if the rule applies to you, and if not, make sure you don’t have any unspent money left! HSAs are different – the funds in an HSA always roll over, year after year.

Post-deductible procedures

Have you met your deductible for 2013? Then the end of the year is a good time to schedule any elective procedures you might want to squeeze in before your deductible rolls over in January. You could save a lot in out-of-pocket costs by getting these services done while your plan is paying at its full benefit level (rather than early in the year when your deductible has not been met).

Onward to 2014!



Tips to Avoid Getting Scammed on the Health Insurance Exchange

Between all the hype over the Federal Government’s insurance exchange website and the tempting business opportunities popping up in health care, a lot of fake sites selling insurance are making their way into the market. Here are some essential tips to help protect your information and make sure you’re buying the right thing!

  • Never give out your social security number or bank/credit card information. You do not need these things to enroll in a health plan.
  • Don’t provide any health information. Health plans sold on the exchanges cannot ask for this or use it to determine your coverage.
  • Make sure you’re not being charged more. There are only 3 ways health plans on the exchanges can vary your premium: age, geography, and family size. If your premium is being raised for other reasons, like gender, race, or health history, that’s a red flag.
  • Check a few sources for links to the place where you’re applying for insurance. If a lot of public agencies and credible organizations are pointing to the site, it’s probably good.
  • Don’t get caught by scare tactics over what might happen if you don’t have insurance. Yes, there is a penalty of $95 or 1 percent of family income (whichever is greater) if you do not have coverage in 2014, which you’ll want to avoid. But some scams exaggerate the penalties to get you to buy insurance.

If you think you’ve found a bad site or experienced fraud, report it to the Insurance Marketplace Call Center: 1-800-318-2596.



Flexible Spending Accounts Now Allow up to $500 Rollover

If you’ve ever had an FSA, you might be familiar with that situation at the end of the year, when you’re either scrambling to spend down the money before you lose it, or you forget about it in the blur of the holidays, and next thing you know, it’s gone.

There’s good news. The US Treasury Department just announced a new rule that would let you rollover up to $500 at the end of each year. For the 14 million Americans that have an FSA, this could mean a lot of savings as well as the ability to be more flexible as you plan your medical expenses.

The new benefit could start as early as 2013, but this may be up to your specific employer. Before you get too excited – employers must decide between offering the new rollover or offering the grace period option, which currently gives you an extra 2 and a half months to spend down your FSA after the end of the year.  Check with your employer or plan sponsor for exactly what your benefits will be.

And if you do find you’re able to take advantage of the new rule, just don’t, uh, forget about the money again the next year, ok?




The Health Insurance Exchanges – What Your Next 3 Months Should Look Like

By now you’ve heard the news that the long-awaited health insurance exchanges are open for enrollment October 1st, 2013. Is the hype making you feel you need to cruise over to the Exchange website right this minute to sign up for a plan? Or so confused you want to avoid it all?

Our tip: walk, don’t run, over to the Exchanges, but make sure you do do it before the year ends. The deadline to enroll is December 15th if you want your plan to start as early as possible (January 1st 2014).

So there’s no rush to enroll but here’s what you should make sure to do before open enrollment closes:

Early October – Determine whether you need to get coverage through the Exchange.

Not everyone does. If you already have coverage through your employer or Medicare, you don’t need to sign up for the Exchange. After all, the idea isn’t to get everyone on the Exchanges, it’s to give everyone an option. So if you’re one of those people who has an incredibly expensive plan, are uninsured, or you’ve been denied coverage because you’re sick, this is for you. Otherwise, this might be something to skip.

Not really sure? Read about how you can benefit from the insurance exchange or the penalty for having no insurance

Late October – Start shopping for plans & gathering the info you need.

If you’ve decided you want to buy coverage from the Exchanges, click on over to to start. You’ll be able to enter your income information too to see if you’re eligible for either a premium subsidy or assistance with co-pays & co-insurance.

November – Do your final comparison and enroll.

Before you choose a plan, always make sure you understand the cost sharing and limitations. Fortunately, the health reform act makes this much easier by introducing standardized tiers of plans (Bronze, Silver, Gold, & Platinum) so you can compare across these plans.

You can breathe a sigh of relief that all the plans on the Exchanges must cover a list of basic “essential health benefits”. But you’ll want to check whether your plan has a provider network and that all of your current doctors and hospitals are part of that network.

When you think you’ve found the plan you want, complete your enrollment online or over the phone. While the deadline isn’t until December 15th, you’ll be glad you got it out of the way before the holidays.

December – Kick back and relax!

Congrats, you just completed enrolling in a new health plan. And just as an epilogue…

January – Starting using your new plan.

February & March – Enroll (for real this time!) if you missed your chance earlier on.

Since it’s the first year for this Exchange business, there is a grace period through March 31st. But beware, next year the deadline is December 15th, period. That means you will be unable to purchase insurance until the next open enrollment in October 2014.

Ready? Set… walk!



2014: What’s the Penalty for Not Having Health Insurance?

By 2014, it’s required that all Americans have some form of health insurance coverage. If you don’t, you will probably have to pay a fine. While that sounds scary, most people are surprised to learn how much they’d actually owe. But before you get excited about skipping out on coverage to save money, make sure you know what you could be missing out on (and what could cost you more in the long run).

How much is the penalty?

The fee for not having health insurance in 2014 will be whatever is higher for you: $95 or 1% of your household income. In 2015, it increases to $325 and by 2016 it will be $695. And if you have kids and don’t insure them, the fine is $47.50 per child.

Who has to pay the penalty?

Pretty much everyone is subject to the penalty, except for a few groups. Some examples of exceptions are:

  • If your income is below the threshold for filing taxes
  • You would be eligible for Medicaid but your state isn’t expanding the program to be available to you
  • You were only uninsured for a small portion of the year (three months or less)
  • You belong to a religion that abstains from medical care or insurance
  • You’re a member of a federally-recognized Indian tribe

What kind of insurance do I need to have?

It’s gotta be real coverage (no skimpy discount plans, or partial coverage such as worker’s compensation or critical disease insurance). Aside from this, pretty much any employer, government, or health benefits exchange coverage will qualify. If you currently have coverage, it will most likely count.

Why not just pay the fine?

There are a couple reasons it might not be smart to go without coverage.

First, you can’t just change your mind and buy it at any time. When the health benefits exchanges open in 2014, they will have open enrollment periods (until March 31st the first year, and then Oct 15th-Dec 15th following years). That means that if you don’t buy coverage during open enrollment, and you don’t have any other options, you won’t be able to buy it for the rest of the year.

Second, you’ll be responsible for the full cost of any health care that you get if you end up needing it. With medical debt as the leading cause of bankruptcy, there was after all, a reason behind the effort to get everyone covered.

At the end of the day (or, perhaps we should say, at the end of March), it will be up to you to decide whether going without insurance is worth the small (but growing) penalty.


Annual & Lifetime Limits – Can your Plan Refuse to Pay?

Good news for patients that get a lot of health care — under new rules from the Affordable Care Act, health plans cannot set annual or lifetime limits on the how much they’ll spend on your care. Before these changes, you could easily reach a limit with a diagnosis like cancer and your plan would stop paying for any of your care.

But there are still a few catches. Here’s what you need to know to make sure you’ll be covered.

Wait for 2014

Lifetime limits aren’t allowed today. But the ban on annual limits starts for plan years that begin January 2014. So that means if your plan year begins at another time (for example, schools and universities often have years that begin in the fall) you may have to wait until then for the benefit to become effective. Until then, the allowed limit is $2 million per year.

Essential Health Benefits Only

Both lifetime and annual limits only apply to what are called Essential Health Benefits. That would be policy-speak for a pre-determined list of standard, basic benefits. This lists prevent plans from trying to include big gaps in the coverage they offer, because all plans sold in the health insurance exchanges will be required to cover them.

Don’t worry, all the basics from outpatient to hospital to preventive care are included. Just remember that any care that you get that is not an Essential Health Benefit can still be capped with a limit.

Find a complete list of the Essential Health Benefits here.

Grandfathered Plans Are Out

Some health plans have been grandfathered out of having to comply with any new requirements in the Affordable Care Act. Plans that were created before March 23, 2010 may have been grandfathered. If you have a plan through your employer, it still may be grandfathered even if you joined the plan yourself after March 23, 2010. You should be able to find out by asking your HR department or plan administrator or looking on your plan documents.

Unfortunately, if you have one of these plans, the lifetime and annual limits are still allowed. If you are anticipating a lot of medical bills, you may want to consider switching to a non-grandfathered plan before 2014.