Look Over Your Healthcare Provider Bills—You Could Even get a Bonus!

I once had a call from a woman reporting that the hospital billed her for her son’s arm brace, when what he really received was an elastic bandage for a sprained ankle.

If you find an error in billing, contact the health provider and the insurance company. Some insurance companies even give a reward to those who find billing errors that would have cost them money! You will probably need to ask your insurance company about such a policy because they aren't that widely publicized.

Examine Your Explanation of Benefits (EOB) Carefully

Your insurance company should send you an EOB for every claim they process for you. It should show you:

• The date you received your health services
• A brief description of the services
• The amount charged by the provider
• The amount allowed by the insurance
• The amount you are responsible to pay
• Remarks that tell how the company processed the claim.

If the amount you are supposed to pay seems too high, call the insurance company. Sometimes insurance companies reject claims because the doctor’s office billed with the wrong billing codes, other times the insurance company may be waiting for you to supply them with more information. With just a few phone calls, you can hopefully have the claim corrected and reprocessed quickly.

If Your Claim is Denied, Consider Filing an Appeal

Many group plans are funded directly by the company for whom they work, and the plan is simply administered by the insurance company. What this means is that your place of employment will have final say over whether a service is covered. If there are special circumstances surrounding the type of medical services you received, your employer may tell the insurance company to allow the charges for you as a special case.