Orlando Harmon
Medical bills can be confusing, and it's not always clear how to re-run them through insurance. It's important to understand your rights and responsibilities when it comes to healthcare costs. If you have a new insurance plan or secondary insurance that wasn't updated before a medical visit, you can usually correct this by providing the necessary information. In some cases, you may need to dispute a bill or negotiate with the healthcare provider to reduce your costs. Understanding the specifics of your insurance plan and the billing process can help you effectively manage your medical expenses.
| Characteristics | Values |
|---|---|
| When to re-run a medical bill through insurance | When the bill has errors, such as charges for services not received or duplicate charges |
| Who to contact | The healthcare provider's billing office |
| What to do if insurance was not applied to the bill | Contact the insurance company and update the "coordination of benefits" |
| What to do if the Explanation of Benefits (EOB) doesn't match the bill | Reach out to the billing team and resubmit the claim |
| What to do if the bill is too high | Negotiate with the billing office, apply for Medicaid, or ask for a payment plan |
| What to do if the bill is from before the insurance policy was active | Some health insurance plans offer retroactive coverage under specific circumstances, such as COBRA enrollment after losing a job |
| What to do if the bill is from out-of-network | Submit a complaint if the care was received on or after January 1, 2022, and meet other criteria |
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What You'll Learn
Understanding your Explanation of Benefits (EOB)
An Explanation of Benefits (EOB) is a document that outlines what costs your health insurance plan will cover for the medical treatments you have received. It is not a bill, but it helps you understand how much your health plan covers and what you will pay when you receive a bill from your provider.
The EOB includes information about the services you received, such as a medical visit, lab test, or screening, and the associated costs. It lists the "Provider Charges", which is the amount your provider bills for your visit, and the "Allowed Charges", which is the amount your provider will be paid. This may differ from the "Provider Charges". The EOB will also show the amount your health plan will pay to your provider, or the "Paid by Insurer".
The EOB may also include information about discounts you received by accessing care or medical products within your plan's network of providers. It will outline any amounts paid from spending accounts, such as a health reimbursement account (HRA), and any outstanding amounts you are responsible for paying.
For some plans, EOBs also show how close you are to meeting your annual deductible. Once your deductible is met, your plan begins to contribute to the payment for services. If you have any questions about your EOB, you can contact your health plan using the phone number listed on the document.
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Comparing your EOB with your medical bill
An Explanation of Benefits (EOB) is a statement issued by an insurance company after processing a healthcare claim. It is not a bill, but rather a report of what your insurance plan will cover, based on the care you received. It provides a detailed breakdown of billed medical services, insurance payments, and patient financial responsibility. It is important to compare your EOB with your medical bill to ensure accuracy and identify any billing discrepancies or overcharges.
To start, verify that your EOB contains the correct personal and provider information. This includes personal details such as your name, member number, and plan information, as well as information about your visit, including the date(s) of service, the doctor or clinic's name, and the type of care you received. Next, review the billed medical services to ensure they align with the treatments you received. Check for any codes or shorthand, which should be explained in a key provided with the EOB.
Now, compare the amount you owe on the EOB to the amount on your medical bill. If they match, this is the amount you will need to pay. It is important to note that you may receive multiple EOBs for the same visit, especially if you received multiple types of services or treatments. In this case, add up the amounts from each EOB and compare the total to your medical bill. If the amounts do not match, contact your insurance provider or healthcare provider to reconcile the difference before making any payments.
Finally, keep in mind that the EOB should also state the reasons for any discounted or non-covered items. These could include an out-of-network physician, a non-covered service, or an unmet deductible. By understanding these reasons, you can gain clarity and control over your healthcare expenses. If you find any errors or discrepancies in your EOB, be sure to contact your insurance company to request a corrected version.
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Knowing your rights under the No Surprises Act
If you have health insurance and receive a surprise medical bill, your health plan may not cover the entire out-of-network cost. This could leave you with higher costs than if you had received care from an in-network provider. In addition to any out-of-network cost-sharing you might have owed, the out-of-network provider could bill you for the difference between the out-of-network provider's bill and the amount your health insurance paid.
The No Surprises Act (NSA) protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. Starting on January 1, 2022, you generally won't be responsible for balance bills or out-of-network cost-sharing when getting emergency care, non-emergency care from out-of-network providers at certain in-network facilities, or air ambulance services from out-of-network providers. When this happens, instead of paying for unexpected out-of-network costs, you'll generally only need to pay your normal in-network costs (like coinsurance, copayments, and amounts paid toward deductibles).
The No Surprises Act also protects you from surprise billing for emergency services if you have a group health plan or group or individual health insurance coverage. It limits the amount of out-of-network cost-sharing, like out-of-network coinsurance or copayments, for all emergency and some non-emergency services. It also limits out-of-network charges and balance bills for supplemental care, like radiology or anesthesiology, by out-of-network providers who work at in-network facilities. The Act defines this limit using a recognized market amount or qualifying figure (like the average fee for the service).
If you don't have health insurance or choose to pay for care on your own without using your health insurance (also known as "self-paying"), in most cases, these new rules ensure you can get a good faith estimate of how much your care will cost before you receive it. If you are charged more than the good faith estimate, you may be able to dispute the charges. For services provided in 2022, you can dispute a medical bill if your final charges are at least $400 higher than your good faith estimate and you file your dispute claim within 120 days of the date on your bill.
If you have a new insurance plan (or had secondary insurance) and didn’t update the information before your visit, send a picture of the front and back of your card to your provider. They will resubmit the claims and make sure they go to the right place. If the Explanation of Benefits (EOB) from your insurance doesn’t match your bill, or if the EOB shows a denial of your claim, reach out to your provider's billing team. They will resubmit the claim to make sure it’s processed correctly. Depending on how responsive your insurer is, this could take between 30-45 days.
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Knowing what to do if you have multiple insurance plans
If you have multiple insurance plans, it's important to understand how they work together to ensure you're getting the most out of your coverage. Having dual coverage is perfectly legal, but proper coordination is crucial to ensure your medical expenses are covered compliantly.
When you have two health insurance plans, one is typically designated as the primary insurance, which is the plan that pays first. This is usually an employer-sponsored or individual plan. The other plan is then considered the secondary insurance, which covers any remaining costs after the primary insurance has paid up to its coverage limits. It's important to note that you may still have out-of-pocket expenses even with multiple insurance plans.
To ensure smooth processing of your medical bills, it's advisable to inform both insurance carriers about your multiple coverage. Most plans have a Coordination of Benefits provision, which helps manage claims billing when a person has multiple insurance policies. This coordination specifies which plan pays first, reducing the duplication of benefits and streamlining the claims process.
If you have a new insurance plan or secondary insurance and forgot to update the information before a medical visit, you can usually rectify this by providing a picture of the front and back of your insurance card. The billing department can then resubmit the claims to the correct insurer.
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Knowing what to do if your insurance plan changes
Understanding what to do when your insurance plan changes can be complex, but there are some key principles to keep in mind. Firstly, it's important to know that health insurance policies typically only cover medical expenses incurred during the period when the policy is active. This means that if you receive medical services before the effective date of your new policy, those expenses are generally not covered retroactively. So, if you had no insurance at the time of service, your new policy will not cover those past costs.
However, there are some exceptions to this rule. Some health insurance plans may offer retroactive coverage under specific circumstances. For example, if you applied for coverage and were approved but had a gap during which you received medical services, your new insurer might cover those expenses once your policy becomes active. This is known as retroactive coverage. Additionally, if you lose your job and enrol in COBRA (Consolidated Omnibus Budget Reconciliation Act), your coverage can be retroactive to the date your previous employer-sponsored plan ended, covering any medical services received during that gap.
To avoid surprises, it's crucial to thoroughly review your new insurance policy. Understand the specifics of your plan, including any exclusions or waiting periods, to make informed decisions about your healthcare and finances. Many policies, for example, exclude pre-existing conditions or impose waiting periods for certain treatments. Always ask your insurance provider to clarify what is covered and what you will be responsible for paying.
It is also important to understand the concept of "surprise billing" and how the No Surprises Act (NSA) protects you. Surprise billing occurs when you receive unexpected charges for services from an out-of-network provider or facility. Starting on January 1, 2022, the NSA protects you from surprise billing for emergency services if you have a group health plan or individual health insurance coverage. Under the NSA, you generally won't be responsible for balance bills or out-of-network cost-sharing when receiving emergency care, non-emergency care from out-of-network providers at certain in-network facilities, or air ambulance services from out-of-network providers.
In summary, while insurance plan changes can be confusing, understanding the specifics of your new policy and knowing your rights under the NSA will help you navigate any unexpected medical bills effectively.
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Frequently asked questions
If you have a new insurance plan, send a picture of the front and back of your card to your insurance provider. They will resubmit the claims and ensure they go to the right place. If the issue persists, contact your insurance company and ask them to update your "coordination of benefits".
File a claim promptly. While there is usually no strict deadline for filing claims, it is recommended to do so within a year of receiving the service.
Most insurance plans classify psychiatrists as ‘specialists’. The cost of visits and the level of coverage may differ from those of preventative care or visits with a primary care doctor.
Receiving a bill before meeting your deductible is not a violation. You are not required to pre-pay for a procedure and can ask for the bill to be sent through insurance first.
Contact the healthcare provider's billing office and ask them to recode and re-bill your insurer.
