April > Be a Wise Healthcare Consumer

Be a Wise Healthcare Consumer

Wait! Don’t Throw That “EOB” in the Trash!

In our busy lives, it’s easy to get overwhelmed with too much mail and email. It can be tempting to ignore your Explanation of Benefits (EOB). But whether you get your EOBs in the mail or electronically, if you toss them out without giving it some thought, you could be throwing money away. Your EOB can help you track expenses, understand your benefits, and avoid paying too much.

An EOB is simply a statement from an insurance company showing how health services are billed and processed. As you’ve probably noticed, an EOB is not a bill but rather an indication of how much is being paid for services and how much you may need to pay. A typical EOB includes sections for basic information about you or your covered dependent, your insurance plan, the health care services received, how claims are processed, special notes about your benefits, and contact information in case you have questions. Each of these sections can hold valuable information for you.

The simplest place to start with an EOB is by checking your basic information. Make sure that your address is correct so that you know you will get important insurance information. Even if you get your EOBs online, the insurance company sometimes needs to send you something in the mail. For example, they may need to send you a new ID card or alert you that they need more information to process a claim. If you need to update your address for any of your UT Benefits, you should contact your institution’s HR/benefits office. They keep the main record of your contact information and will send the update for you.

A further review of your personal and claim information can be an important step in preventing healthcare fraud and medical identity theft. The wrong name, address, group, or ID number could be a simple mistake, but it could also mean there has been unapproved use of your medical identity. If the descriptions or dates of services don’t seem right, that could mean services have been claimed that weren’t provided to you. Intentionally incorrect claims not only cost the plan money, but can also lead to false entries on your or your dependent’s medical record. If you notice anything that seems wrong with your claim information, you should contact your healthcare provider and the insurance company to find out more.

The most complex section of an EOB is probably the service and coverage detail. There’s a lot of information here showing what has been billed, what has been paid, what you may owe, and whether any or all of the claim has been denied. This section will also show reason codes and explanations if any of the charges that are not allowed. Nearly all claims are processed automatically and paid correctly, but some do require special handling and mistakes sometimes happen. Errors can happen if something is incorrect or incomplete when the claim is submitted or when the claim is processed. If the amount that the EOB shows you may owe to the healthcare provider is different from what you paid or expected to pay, there may have been an error. If you have a question about how a claim has been processed, the best place to start is by contacting customer service to find out more (phone numbers to customer service are listed on the EOB).

Once you’ve checked everything on an EOB, it may still be worth some money to you. If you or your covered dependents have another insurance policy, the EOBs can help you keep track of the coordination of benefits between plans. If your family has a flexible spending account (FSA) like UT FLEX, an EOB is usually the best document to submit with an FSA claim. And finally, if you itemize deductions for medical and dental expenses on your income tax return, you will want to save your EOBs for documentation.

Taking the time and effort to learn about your benefits and review your claims by reading your EOBs carefully is definitely time well spent.