Managing your Cost

The cost of your health care is more than just the premiums that you pay each month. This section of the guide will explain the kinds of costs that you may experience and also some of the calculations involved, to give you a better understanding. This section also offers advice on how to handle unexpected costs and how to understand your bill.

Topic Area: Don't Overpay!

What should I do if I the charges on my Explanation of Benefits statement don’t match the amount the facility or my provider is billing me?

Billing mistakes can happen. If the amount on your Explanation of Benefits (EOB) doesn't match the bill from your healthcare provider, take the following steps :

  • Collect all of the paperwork. Sometimes more than one EOB applies to a single bill.
  • Compare the codes/descriptions of services from your EOB and your medical bill and make sure that they match and look for duplicate charges.
  • Review the services to make sure that only services that you received are listed, and that the amount you owe is consistent with your health insurance benefits.
  • Make sure that your name and policy number are correct. You don’t want to be billed for someone else’s healthcare services.
  • Call your healthcare provider’s office (or the business department at hospital or medical facility where you received services) and ask them to review the bill with you. Make sure it includes only the services that they ordered and that you received. If there was an error, be sure to ask about the process to correct the billing.
  • Request an itemized bill from your healthcare provider or the facility. Review this for possible errors or items that don’t match your EOB.
  • Contact your health insurance company and ask about the differences between the bill and EOB. You may be able to take all of your paperwork into your insurance plan’s customer service department and get help in person.

Keep notes of who you spoke with and the dates of your conversations. Note any actions they are to take. Follow up if you don’t receive a corrected bill if there was an error identified.

If you were denied health insurance coverage for a service, learn more about what to do if your claim is denied.


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