I usually toss my Explanation of Benefits (EOBs) into a basket, then later throw them out without any review.
I have Medicare with secondary coverage from United, and I get sequential Explanations of Benefits (EOBS) from each.
Here are some of the reasons I can’t figure out whether or not my claims have been processed correctly.
– The Medicare and United EOBs are different and it is difficult to try to link them
– Each has a separate deductible and it’s hard to track
– Some secondary insurers “outsource” certain categories of service such as rehab/chiropractic generating additional EOBs
– I also get a periodic Medicare Part D report, for the Prescription Drug benefit
– If Medicare doesn’t pay then United won’t either even if United would pay if it was primary. For a given provider the secondary co-pay is different depending on whether or not the provider is in or out of network, no matter that Medicare pays
– Every provider codes claims differently so similar service at two providers may be coded and billed differently.
– When I got PT in two different places one charged me $20 per visit, the other calculated a co-pay for each visit.
– I am going to a chiropractor who accepts Medicare and is out-of-network for United so I will not know my out-of-pocket costs until I get both EOBs.
– Medicare and United have different appeal procedures. If I can’t link the EOBs it’s impossible to know where to appeal
Here’s a personal frustrating example:
In early December I received a bill and paid $205 for a lab test done at a reference laboratory. No insurance claims had been processed.
After I followed up, in March I got an email: “I contacted XXX and spoke with ZZZ. Per ZZZ Medicare processed and made payment on one of the charges but denied the other (processed the $82.00 charge denied the $123.00 charge). He is confirming the reason for the denial for the second charge and will work with Medicare regarding processing it for payment. Currently you have a credit of $73.38 however Empire has not processed and paid for the $8.62 coinsurance applied by Medicare. ZZZ will submit that as well.”
As of April 9th, still not resolved.
We are “collateral damage” in a war between hospitals and insurance companies. *
The obvious but unlikely solution is universal coding/ claims/ EOB by all providers, integrated to simplify tracking of a claim through primary and secondary insurers.
to learn more about EOBs you might look at:
What is an EOB? http://www.medicalbillingandcodingu.org/what-is-an-eob/
Understanding Your Explanation of Benefits http://www.patientadvocate.org/index.php?p=441
Understanding Your Explanation of Benefits (EOB) – How to Decipher Your Explanation of Benefits https://www.verywell.com/understanding-your-eob-1738641
Two “must read” articles:
Markups On Care Can Fatten Hospital Budgets — Even If Few Patients Foot The Full Bill, by Chad Terhune. Kaiser Health News. http://khn.org/news/markups-on-care-can-fatten-hospital-budgets-even-if-few-patients-foot-the-full-bill/
Those Indecipherable Medical Bills? New York Times. by Elisabeth Rosenthal. https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html