* Failing to send explanation of benefits
statements that contained all the wording required by law for certain claims which were denied in part or in full.
It is important to regularly compare Explanation of Benefits
statements with billing claims to verify that you are being paid correctly.
In my case, I used Healthcare Blue Book and found the allowed amount for an intermediate office visit as well as the lab tests by using the descriptions from an old explanation of benefits
. I called the non-par specialist's office and suggested that I was willing to pay them directly.
Another exciting part of health care reform is that doctors' offices and hospitals are now required to code all claims correctly so there is no longer a need to question your EOB (explanation of benefits
) when you receive it.
He covers "EOBs" (Explanation of Benefits
) and medical bills in detail, providing helpful advice for how to read bills and understand charges.
When immediate payment is impossible, or you must wait for the insurance explanation of benefits
, ask for a credit card number that you can keep on file and charge as soon as you know the balance due.
Compare explanation of benefits
with bills: Crosscheck the insurance company's explanation of benefits
statements with itemized bills from the hospital and doctors.
When providers get paid via ACH, they can match their payments with the explanation of benefits
(EOB) forms that health insurers use as remittance documents, Monahan explains, by viewing or printing out the EOBs.
The "Medicare recipient" held up a copy of the EOB (explanation of benefits
) that detailed his wife's stay in the hospital.
It is probably worth reviewing some past explanation of benefits
to determine how often Medicare is a secondary payer, and whether any extra revenue will be worth the extra vigilance and work involved.
United Automobile Insurance Company is praising a Florida-based ruling from the Third District Court of Appeals that confirms a person cannot sue his auto insurance company for failing to provide an explanation of benefits
on personal injury protection claims.
Significantly, the preamble to the rule initially promulgated to implement the statute made clear that this protection can be used to mitigate the threat posed by EOBs: "For example, if an individual requests that a health plan send explanations of benefits about particular services to the individual's work rather than home address because the individual is concerned that a member of the individual's household (e.g., the named insured) might read the explanation of benefits
and become abusive towards the individual, the health plan must accommodate the request." Although this rule was subsequently revised and reissued, the later version made clear that changes were not being made to the provision on confidential communications.