{"id":178,"date":"2013-05-22T13:27:57","date_gmt":"2013-05-22T21:27:57","guid":{"rendered":"http:\/\/www.keenanpowell.com\/blog\/?p=178"},"modified":"2013-05-22T13:27:57","modified_gmt":"2013-05-22T21:27:57","slug":"explanations-of-benefits-confusing-and-tiresome-but-important","status":"publish","type":"post","link":"https:\/\/www.keenanpowell.com\/blog\/2013\/05\/22\/explanations-of-benefits-confusing-and-tiresome-but-important\/","title":{"rendered":"Explanations of Benefits: Confusing and Tiresome but Important."},"content":{"rendered":"

An Explanation of Benefit (sometimes called \"Explanation of Medical Bill Payment\" or \"Explanation of Review\") is the document that an insurance company is required to send you when it receives a bill from your health care provider.\u00a0 The insurance company is required to tell you if it is going to pay the bill and if it is not, why not.\u00a0 The forms are difficult to read but it is important to take the time the time to understand what the insurance company is saying because it might be screwing you.<\/p>\n

If the insurance company is denying the bill, then it needs to explain the reason.\u00a0 Frequently the company will reference a code in its explanation but doesn\u2019t give you the codes.\u00a0 If that happens, send a letter (USPS priority so you can track receipt) demanding the codes.\u00a0 And keep a copy of that letter.<\/p>\n

Read the reason for denial.\u00a0\u00a0 If the insurance company is wrong, then follow the procedure that the insurance company provides for appealing the decision.\u00a0 Some insurance companies will spell out a particular procedure on the back side of the form and there will be deadlines.\u00a0 Follow the procedure to the letter.<\/p>\n

If your EOB doesn\u2019t have a procedure, write to the insurance company and explain to it why it is wrong.\u00a0 Again, keep a copy of the letter and track its delivery through USPS.<\/p>\n

Sometimes, your automobile insurance company may deny payment of a bill because the bill was not coded as a motor vehicle accident.\u00a0 Assuming that the bill is a legitimate cost of treating your motor vehicle accident injuries, then you need to call the billing department of your provider and explain to them the coding problem.\u00a0 The billing department\u2019s telephone number will be on the bill that they sent you.\u00a0 They are generally very helpful and would be happy to do what is necessary to smooth out a problem.<\/p>\n

Insurance companies are under an obligation to deal with you in good faith and there are several specific mandates that they are required to obey:\u00a0 A person may not commit any of the following acts or practices:
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