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).
It 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.
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.
When it comes to your individual medical insurance, do your homework and prepare in the event of inflated bills or medical identity theft. It may save you money.
