It may not be a bill, but it shows which services and how much money your doctor is asking your insurance company to pay. You should care because chances are you're paying a premium for your health insurance. In the insurance world, premium amounts are affected by the number of claims filed on your behalf, which can mean that your premium may increase, due to excessive appointments and health services provided. Also, if your doctor is billing your insurance company for services you didn't receive, then that's a red flag, indicative of fraud.
Sometimes, doctor's office staff will bill you directly for the entire amount, instead of billing your insurance company. Is it fair? Maybe not. But you have to do your homework to determine that. Try verifying your benefits yourself, and do it before you step foot in the doctor's office; it's customary that office staff verify benefits before an appointment is made, but often times, it's NOT done.
When you verify your benefits, you will be better equipped to educate office staff about whether you are obligated to pay. Since it's customary that office staff verify services covered by your insurance policy, knowing your coverage and payment amount will help you avoid confusion and frustration, while also keeping money in your purse or wallet.
So, be careful not to get talked into paying full price for health care services, especially when you have a health insurance policy in force. Otherwise, you're paying for a service unnecessarily, and may be due a refund.
Now, if you do not understand the insurance documents with the statement "This is not a bill" across the top that come in the mail, let's fix that right now! Yes, there may be some medical codes on there that you may not understand. However, you certainly understand dates and dollar amounts. So, take a look at the dates on your EOB or Explanation of Benefits and confirm whether you went to the doctor on those dates. Read the summary of health services, and make sure that the services billed for were indeed delivered to you or for your benefit. Also, look for the physician's name on the EOB, making sure that the doctor or health care provider listed is correct, as well as the amount "due" by the patient, which would be you.
In the event that you locate information on the EOB that is wrong, call your insurance company. It's okay to also call your doctor's office, but understand that whatever explanation is provided to you over the telephone needs to be backed up in writing. By this, I am referring to receipts, EOB's, letters (on appropriate letterhead) from your insurance company and doctor's office.
Golden rule: If it's not in writing, it didn't happen.
I hope this helps! If you have questions, e-mail me at adminbydom@gmail.com
Have a safe weekend, and don't take any wooden nickels =)
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