Over the last two weeks, we have discussed Reading Your Medical Bills and Explanation of Benefits. Now that we are familiar with each of these documents, today we are learning how to cross-check medical bills and explanation of benefits for accuracy.
Important Fields:
Medical Bills/Explanation of Benefits
The most important field on the medical bill is the patient balance field. (#3 & #9 on the example bill provided) This amount should always match the amount found in the Your Share of the Cost field (#8 & #10 on the example EOB provided) In our example documents, you see that these items do match for an amount of $223.65. Take a look at both documents and find these matching fields.
Examples:
Medical Bills/Explanation of Benefits
Explanation of Benefits Page 1
Explanation of Benefits Page 2
Item of Interest:
Notice that the total of the medical bill does not match the total of the Explanation of Benefits. This happens when there are multiple dates of service and multiple claims to review. In this situation, the Explanation of Benefits only shows information for the doctor visit on May 13th while the medical bill shows information for the doctor visit on May 13th as well as the lab work done on May 19th and the follow-up doctor visit on June 3rd.
Do things Match?:
Medical Bills/Explanation of Benefits
The Explanation of Benefits in the example above shows that I owe $223.65 for the doctor’s visit on May 13th. This amount has been applied to my deductible according to Blue Cross Blue Shield of Tennessee. When I look at the medical bill, it also indicates that I owe $223.65 for the doctor visit on May 13th. AWESOME! These numbers match!
**Remember; the matching numbers are for the May 13th doctor visit only.**
The Numbers Match, Now what?:
Medical Bills/Explanation of Benefits
Now that I know the doctor visit on May 13th has been processed with my insurance and the amount my insurance says I owe is the same as the amount the medical bill says I owe, I am ready to make a payment. WAIT. I am ready to make a partial payment. I am happy to call the billing office and make payment for the doctor visit on May 13th in the amount of $223.65. When making payment, the office will most likely ask me to make payment in full. I will politely advise them that I am waiting for the Explanation of Benefits for the other services before making payment. I will also ask them to please make note of this in my account notes for future reference.
In Conclusion:
In conclusion, cross-checking medical bills and explanation of benefits is the third and final step in only paying what I owe. If you missed the first two steps, check them out: Medical Bills: Learn How to Read Yours and How to Read an Explanation of Benefits.
Don’t forget to pick up the Medical Bill Checklist I use to review my own medical bills!
Next month we are talking about open enrollment! What are your biggest questions about open enrollment? Email them to me at NBroadhurst@TennesseeHealthAdvocates.com
As always, if you find yourself needing more assistance, please reach out to me directly at NBroadhurst@TennesseeHealthAdvocates.com
