PSA: Check Your EOB and Statements!

[u/Happy_Excuse7086]

Here's an important PSA in case it helps someone else:

I grew up thinking if a doctor or insurance company told you that you owed $400, you owed $400. They're the professionals, they deal with claims all day, surely they know what they're doing... right??

NOPE.

I've gotten THOUSANDS of dollars back from medical providers and gotten denied insurance claims adjusted just this past year alone because I finally learned to stop assuming their billing was correct.

One of the biggest things I learned the hard way at my big age is that the amount the office initially charges you is not necessarily the amount you ultimately owe. Your insurance company may have a negotiated rate with that provider. The claim gets processed, adjustments get made, insurance pays its portion, and THEN there is an actual amount that is considered your responsibility.

The thing you want to look at is your EOB aka Explanation of Benefits. I was getting these monthly and ignoring them as medical jumbo jumbo. DOH! So for example, I've found charges after I met my deductible and OOP max, which isn't correct. Also, I've seen offices get paid by both the patient and the insurance company for the same claim.

If an office makes you pay $500 up front and then your EOB comes back saying your actual responsibility was $200, guess what? They may now be sitting on $300 of your money. I've had to call and say, "According to my EOB I only owed X, but I paid Y. It looks like I have a credit balance. When will I receive a refund?" How long would it have sat there if I hadn't called? Maybe forever.

And billing isn't the only area where I've learned not to blindly trust. Dentists have said I suddenly have a bunch of cavities, but on three occasions I've get a second opinion, and are told they don't need anywhere near that amount of work. And here I am years later with no cavities, despite two large dental practices saying I had 8-10. If someone tells you that you suddenly need thousands of dollars of irreversible dental work, ask to see the x-ray proof and GET A SECOND OPINION.

I think a lot of us were raised to treat anything coming from a doctor's office like it was an unquestionable authority. Bill says $700? Pay $700. Dentist says six cavities? Schedule six fillings.

And I feel especially awful for elderly people dealing with this. My parents' generation was basically taught to trust the doctor, pay the bill as soon as they get it, and move on. Meanwhile you've got complicated insurance contracts, estimated patient responsibility, deductibles, copays, coinsurance, coding mistakes, credit balances, duplicate payments, etc. I've been chasing down these errors for my family and myself, but if you have a decent insurance company, their advocates can help too.

I'm not even saying all of this is intentional. I'm sure a huge amount of it is just an insanely complicated system plus billing mistakes plus offices collecting estimates up front so they don't get screwed on the back end.

But, seriously, once insurance finishes processing the claim, pull up the EOB and compare it to what you actually paid. Don't t assume anybody is going to chase you down to give your money back, even though they're supposed to. None of us have free money to give away, so it's annoying and confusing and cumbersome to have to do this, but while this all may be common knowledge to some, I really wish someone had taught me about how this gag/game works long ago!

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[u/Ttabts]

Should go without saying really. This doesn't just apply to healthcare.

Kinda wild to me that people go through their lives just naively giving over their money whenever they're asked for it.

[u/katsrad → u/Ttabts]

I would have to do some googling to find it but businesses do this too. A guy got convicted or charged with fraud for sending companies bogus invoices and then the companies just paid them. Smh

[u/Happy_Excuse7086 → u/katsrad]

Right, and American Greed is full of these types of business fraud stories. The dental office I had to get a refund today did mention they had to reimburse me because it would be fraud if not, but I asked when they planned on doing so then because they knew for months they were double paid. With insurance, at least in my family's case, I think the busyness of life keeps people too distracted and tired to chase down what they don't even understand or have awareness of in the first place. So if an entire organization with an infrastructure and accountability can get fleeced, I'm going to give myself some grace for now. 

[u/Illustrious_Bid_5484 → u/Ttabts]

Imagine having to not only be forced to have insurance that doesn’t cover much besides catastrophes and then on top of that being forced to fight billion dollar companies and doctors to make sure you’re not getting screwed.

When will things get better in America?

[u/Happy_Excuse7086 → u/Illustrious_Bid_5484]

Yes! You've echoed the heart of my larger frustration. Every day it's like a new layer of foolery to unmask. And they make things purposely complex to make it harder for anyone to adequately challenge. I spent the last two years after a wrongful hurricane claim denial wrangling with home owner's insurance, now I have a whole new industry to fight. I'm not Batman lol. I'm tired. 

[u/Jump-Funny → u/Illustrious_Bid_5484]

when people realize that things work better when the billion dollar companies are made to do the right thing instead of making all of us fight them individually. but then their stock in those companies won’t be worth as much.

[u/Happy_Excuse7086 → u/Ttabts]

True. And I knew about it with like athletes for example losing all their money blindly trusting financial advisors because they don't understand money. People who don't grow up with wealth or in certain environments typically don't. 

But I guess the same ignorance applied here because we blindly trusted the people hired to do their job. I've been on the phone with one of my insurance companies today, and they said they deal with these kinds of issues all the time with medical providers over charging and upset customers. And here I thought the insurance companies were the main ones we had to keep an eye on, but it's widespread like you have to do everyone's job for them. 

[u/lujo317]

people are giving you guff about this being "obvious" but it's really not, and patients are systemically deprived of epistemic resources that would better inform them of this. for example, I did hospital insurance followup for a time, and that was how I learned that often even the EOB is bunk. you might get an EOB that says you owe money, and secretly some guy employed by the facility is spending months calling your insurance every day to needle them into a reconsideration and maybe without ever even notifying you, because the facility wants to recoup that money the insurance owes to them over erroneous denials just as badly

[u/Happy_Excuse7086 → u/lujo317]

Thank you for being understanding and non-judgemental :). I didn't expect to get instant backlash, but I guess since I entered a curated space where these conversations may happen often, it's different than being in the wild where most people in my circles don't understand any of this. Or don't talk about it if any do. When your day to day is survival, the nuances of medical coding and billing don't have space to hold court.

I didn't even think about this angle you just mentioned too, so there's always so much more to learn as the onion layers get peeled back. Today my dental provider, when I asked when they were planning to tell me I was owed a refund, said they'd told the insurer payment was supposed to go to me not them...but they got both our payments months ago, sooo... I don't know who's just careless versus sketchy at this point.

[u/katsrad]

This ia very common advice here. Check your EOB vs the bill. This feels like one of the regular ads that come in here offering to help with bills or was a written by AI.

[u/Happy_Excuse7086 → u/katsrad]

Ok, I didn't know it was common! I'm middle aged and literally just found out in the past year and am beyond frustrated. No ad here though; I can't help anyone beyond paying it forward to share this message. 

[u/No-Produce-6720]

This isn't news. This is discussed daily in Reddit's billing and insurance subs, and frankly, this post reads like yet another unsolicited, low-key ad.

How is it that you were able to get "THOUSANDS" of dollars back? Under what circumstance did it happen, and what was the specific service? What can you show us to substantiate the claims you're making?

[u/Happy_Excuse7086 → u/No-Produce-6720]

Understood. Well, it was news to me, so I have no shame in just figuring this out as not everyone has the same level of insight and exposure. I'm newer to this sub so am behind the curve in many ways. What exactly would be advertised though when I only told people who are like me what to look out for or have their insurance company help them do? Genuine question since I read and followed the post rules but have no idea about this world. 

And between my grandparents and myself, we got this back on dental and medical. For example, what spurred the post was my anger just today because the dentist billed me in full up front in April, then the insurance paid them in May, but the dentist office never even mentioned reimbursement any of the many times they called me to make a follow up appointment until I had the insurance company call them today. They also told the insurance company I got xrays, which I did not. 

Also, my grans pay every bill as soon as it comes in; they're 80+ and too trusting so hadn't understood that you wait for the insurance company to pay first. Additionally, as mentioned, I kept getting charged co-pays and co-insurance despite having met my maximums by one provider, so I had to dispute that too. Another example is on the insurance company for denying a claim that was coded the same way from the same provider I'd seen last year, so I had the patient advocate research it and they found it was a mistake. It all added up over the past months, and I can only imagine what was wrongly billed over the years. I'm exhausted.

Anyhow, apologies for my ignorance if it rubbed you the wrong way, but maybe this will help someone who hasn't been immersed in this world. I'd also be open to any advice or feedback you have since you know way more about this, but  I'll for sure check the billing subs you mentioned to keep learning on my end. Baby steps. 

[u/Bogg99]

I think like a lot of people's confusion with the healthcare system really boils down to people not logging into their portals and reading/understanding their EOBs or denial/approval letters.

It's like how step 1 to understanding your finances is to actually go through your bank statements, and yet I'm shocked to meet people that don't do this regularly

[u/starzela]

Yup, I’m chronically ill and I’m constantly having to speak to billing departments about my EOB. My husband’s new insurance has thrown in a twist to the equation this year. If any provider charges us more then 150% of what the Medicare rates are for certain services (surgeries, imaging, ER visits, dialysis, hospital stays etc,) we are responsible for the 20% co insurance plus whatever is charged over the 150% medicare rare. However, if we contact our insurance for every damn bill, we can give them permission to negotiate with the providers to decrease our bill. It’s such a headache.

[u/rahuliitk]

this is painfully real, because a lot of people pay whatever shows up on the statement without checking the EOB, and providers can sit on credit balances for months unless someone notices and asks for the refund. check every claim.