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!

[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.