Here’s some things to try to find out why your bill was not paid:
Review the Explanation of Benefits (EOB) from your insurance company:
- Check for errors
Make sure the basics are correct like your the spelling of your name and your insurance ID.
You also should check to see if the services listed are what you actually received and have the correct date of service.
- Review the denial reasons why your insurance did not pay the bill
Every insurance company uses their own system of denial codes which states why they did not pay your bill. Often times these codes don’t make much sense and you need to call your insurance company for an explanation.
Read your insurance plan:
- It’s important to know the details of your insurance plan. You’ll want to understand what your plan covers and does not cover, how your bills are paid at in-network and out-of-network services, and when you need to call for pre-authorizations for surgeries as a few examples.
- You can call your insurance company to get errors corrected or get your questions answered. If you feel like you are not getting the help you need, you can ask to speak with a supervisor.
Errors by insurance companies do happen and should be corrected. Sometimes there are errors in the original bill from the doctor or hospital and you can request the insurance company follow up with your providers to get issues resolved.
Advocate for yourself:
If after you have done the 3 steps above (Reviewed your EOBS, read your plan, contacted your insurance company) and your insurance company will still not pay your bill and you believe their decision is incorrect, there are things you can do.
- You can file an appeal to your insurance company documenting why your bill should be paid.
Every insurance company has their own appeal process, so you will need to talk to your insurance company to find out how to file an appeal and what forms you need to use.
Insurance statements can be confusing but by taking some time to understand how your bills get paid, it can pay off in the long-run.
Being your own advocate makes you a more well-informed health care consumer. Hopefully will save you money on your medical bills, too!