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November 22, 2008


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As a further reminder, keep an eye out for "balance billing" which is where a provider improperly attempts to collect from you an amount in excess of what they contractually agreed to receive from the insurance company.

*Always* check your medicals bills and insurance statements, and if there's something you don't understand, ask.
Coincidentally I actually work with medical claims, and I can tell you the errors both from the medical providers and from the insurance companies are both absolutely legion.

No doubt, insurance statements and hospital bills are designed to be incomprehensible. I recently got a fistful of them and, although I parse complicated documents all day long at work, I am not confident I understand them. However, I don't have to dig my heels in until someone actually tries to collect something from me. So far so good.

My insurance provider must have stock in a paper company. I get tons of the "EOB's" (Explanation of Benefits), that really don't explain anything. They might be able to save us some on those sky high premiums if they could find a more efficient mechanism to communicate this information.

However, here is another reason to check them carefully. I had gotten into the habit of setting the all-to-familiar EOB's aside until I had a pile of them and then sorted thru them to file them away in batch. For some reason, in two instances now, the ins company has attached a check to the bottom of the EOB for the benefit amount. The first time it happened I didn't realize it until I got a bill from the Dr office stating I had a balance. I knew that shouldn't be the case so I started digging thru my stack of EOB's.

When I asked the Insurance company about this, they could only tell me that sometimes they separate certain claims and pay the member instead of the provider.

This is particularly timely advice as many struggle to make ends meet and look to reduce costs elsewhere in their lives. Doing out-of-network visits for anything routine or even problems that can be solved by general practitioners is not a smart investment in most cases.

Best of luck!

You also need to be aware of your benefits. This year our insurance started providing well visits (check ups, immunizations, etc) with no co-pay. Our pediatrician charged us co-pay for my first child. The second child, I told them I wasn't paying because I knew my benefits covered at 100%. Well, a few weeks later I received a bill. The EOB (about the only one I received this year) I had received from the ins co clearly showed no payment owed by insured. I fought and fought with billing before they would finally call the insurance company. I received my refund 3 days later.

We spoke with HR & the insurance company about it, and apparently we aren't the only ones this happened to. They are "supposed" to make changes to our cards for next year. We'll see.

You might also need to check with your different medical providers if you are owed money. Many just put a credit on your account. If it is the kids' pediatrician, not a problem. We are in there quite frequently for sick visits. Anyone else, I call to request the refund be mailed to me.

Adam- sometimes you can change your options and receive EOBs online, so you don't get a stack and only need print the ones you need.

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