Bills to Benefits

This week, I’m going to give you a little education about bills to benefits.

You know, I talk and talk and talk about your bills and check everything. It is so important.

Let me share a story with you…

Recently, I got a phone call from a client that received a $1,300 lab bill.

  • They didn’t understand it as they had checked that the lab was in the network
  • So I went onto her online portal and looked up the plan that she had, and her labs are supposed to be a $50 copay.
    • I asked her, “Do you have the explanation of benefits, or EOB?” (from the insurance company. My concern was, that maybe it was a specialty lab, that the insurance disallowed.
    • The EOB was found by the client, and we discovered that the insurance did process it correctly, and it showed on the EOB that she owed $50.
    • She needed to then call the lab and tell them that they had processed incorrectly and that she only owed $50.
    • This client was shocked and now wonders, “How many times have I overpaid.?”

We can all learn from this.

Usually when it’s a smaller amount, sometimes we don’t pay attention, and we just pay the bill.

But the point we need to remember is that we don’t want to overpay. No matter how big or small the amount.

And the only way to do that is to do your due diligence, think of it as similar to reconciling bank statements.

  • You need to get the EOB out
  • Look at it
  • Keep it handy, and then when you receive a bill, match it against what the insurance says you owe.
  • Sometimes insurance does process things incorrectly, and then you can ask for an appeal, and get them to reprocess the claim.
  • But, as in this case, the claim was processed correctly by insurance, and it was a lab that didn’t apply the payments and adjustments correctly.

Make sure that even on the small amounts, you’re not overpaying for your services. Compare any bill you receive with the explanation of benefits from insurance and make sure those match up.

And if something was denied by insurance, let’s figure out why.

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Austin, Texas

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