With ample opportunities for billing errors within today's
complex health care claims and reimbursements systems, it's
a wonder people carrying individual medical insurance don't
spend more time carefully checking each Explanation of
Benefit (EOB). The EOB shows what was charged less what the
insurer agreed to cover, the balance being what you owe.
Checking your EOB is the first line of defense against
overpaying on a health insurance claim.
Your EOB may not reveal a lot, but you can check to see
that your name, address, and policy information are
correct. You should also confirm that you were charged the
"allowable" rate set by your insurer and not a penny more.
Deductibles can be as high as $10,000, and payment comes
entirely from your bank account, which makes group
discounts all the more important.
Other common errors the EOB may reveal include: Failing to
get credit for a deductible that has been paid, in-network
providers classified as out-of-network, legitimate claims
denied as "medically unnecessary," "upcoding" (being
charged for more expensive services than you received), and
"unbundling" (when a single procedure is broken down and
billed as many). At Blue Cross/Blue Shield's Web site
www.bcbs.com/betterknowledge/anti-fraud/explanation-of-benef
its.html, there's a brief tutorial on how to read and
double-check an EOB.
According to a 2001 Harvard study, illness and its
associated costs are responsible for 50 percent of all
bankruptcies, so it literally pays to request itemized
bills from hospitals and other service providers. They are
your next line of self-defense against overpayment. The
problem is making sense of them, which may require hiring a
patient advocate.
Lee Taber works for HealthCare Mediation Group auditing
itemized bills, coordinating appeals, and, when possible,
negotiating reduced payments and workable payment schedules
to keep clients from getting a damaging credit rating.
While costly mistakes are rare, Taber estimates that 40 to
50 percent of hospital bills contain errors: "The potential
for error is high when a bill is 15 pages long and lists
every aspirin and other medical supply."
Advocates receive a percentage of the money they save you.
Their cut varies but can run as high as 30 percent. He
concisely sums up the benefit of working with an advocate:
"If you don't know what you're looking for, how would you
find it?"
Indeed, visit the Individual Services page at Medical
Billing Advocates of America at www.billadvocates.com/
where you can read about a patient who was charged $12 for
a "mucus recovery system" —a box of tissues.
If paying someone to fix a mess you didn't make gets you
mad, imagine being the victim of medical identity theft.
It's like losing control of your social security number and
private financial info, but this is a loss that can be
deadly. If a phony claim is made using your benefits, your
chart could contain wrong information when you need urgent
care. If your benefits are tapped out by an impostor,
you'll have none left for your own care. According to a
World Privacy Forum report on the crime, all levels of the
medical system may be involved, in addition to organized
crime.
When it comes to your individual medical insurance, do your
homework and prepare in the event of inflated bills or
medical identity theft. It can save your money and your
life.
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Ryan Patterson is president of US Insurance Online, based
in Austin, TX. He graduated in 2000 from the University of
Texas with a combined business and computer science degree,
and started US Insurance Online in May of 2005 with fellow
entrepreneur Jim Waltrip. Visit
http://www.USInsuranceOnline.com for help shopping for
insurance and for free insurance quotes.
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