EOB vs. Doctor's billing

[SumDay]

DH has been on Medicare for 1.5 years now, and his Part G Supplement is through Humana. I've been really pleased with how well they've paid.

However, about half the time we get these little bills (<$10) from a doc or service provider, even though the Explanation of Benefits (EOB) from Humana shows we owe nothing after Medicare and they have both paid. I've been able to reconcile these over the phone.

Today I got a collection notice for $5.15, even though I sent them the detailed EOB showing we owe nothing. Obviously the $5.15 won't break us, but it's the principle of the thing - that's why we got a Part G. FYI, this bill is from September, and he'd already met his deductible much earlier in the year.

If you have this trouble, how do you handle it?

 

[REWahoo]

If you have this trouble, how do you handle it?

I've not had that happen but if I did I think I'd send them a copy of the Medicare EOB as you did and include notice you weren't going to pay the bill as is isn't a legitimate charge. I would then ignore any future notices for payment.

 

[frayne]

Trying to understand insurance EOBs and modern day medical billing would make the Pope curse.

 

[SumDay]

Trying to understand insurance EOBs and modern day medical billing would make the Pope curse.

No $hit...

 

[JoeWras]

Trying to understand insurance EOBs and modern day medical billing would make the Pope curse.

Or give someone a few slaps.

Funny, I'm on the phone with BCBS right now (waiting 1 hr) to answer a simple question about a generic statin that runs pennies a tablet. What's my question? Well, why are you putting restrictions on the pharmacist to fulfill this? This is not an opioid, nor is it a $10 per tablet drug.

The website is useless. It says there are "frequency restrictions," provides a link to explain them, which then goes nowhere.

Yeah, frequency restrictions. You know, I may try to buy a bunch of these and resell them on the street or something.

 

[Rianne]

I'm not on medicare, yet. Our ACA Health Alliance plan has an online explanation of every charge. I only pay medical bills according to the EOB.

When I went into the ER, three times in a month, had 2 CT scans and multiple other x-rays, meds etc. the EOB outlined and listed every charge. Then took off the insurance discount per charge. The difference was incredible. Hospitals charge whatever they please. The insurance discounts and final EOB total is what I pay.

 

[pb4uski]

DH has been on Medicare for 1.5 years now, and his Part G Supplement is through Humana. I've been really pleased with how well they've paid.

However, about half the time we get these little bills (<$10) from a doc or service provider, even though the Explanation of Benefits (EOB) from Humana shows we owe nothing after Medicare and they have both paid. I've been able to reconcile these over the phone.

Today I got a collection notice for $5.15, even though I sent them the detailed EOB showing we owe nothing. Obviously the $5.15 won't break us, but it's the principle of the thing - that's why we got a Part G. FYI, this bill is from September, and he'd already met his deductible much earlier in the year.

If you have this trouble, how do you handle it?

I would resend them the EOB and emphasize that the EOB proves that the debt is not owed and that is the reason that it hasn't been paid and that you dispute that debt and that they need to vallidate the debt under the Fair Debt Collection Practices Act before proceeding any further. That will put the onus on them and the provider to make sure that you owe the debt before they harrass you any further.

 

[SumDay]

Closing the loop here: After spending way too much time on the phone with their outsourced billing company, and trying to make my fax talk to their fax, I found an email address on the provider's website. I scanned the EOB & bill, emailed it to them, and got this response back in 15 minutes:

"Our apologies for the billing error. I have sent the information to our billing company and to cease billing the patient as the patient balance should be $0.00

Thank you so much for bringing this to our attention.

Have a great day!

June"

 

[pb4uski]

But you know what I think that they do... I think that these "billing errors" are intentional because many people don't question them since they don't understand them or what they should legitimately need to pay for... they just say to themselves that it's only $5-10 and just pay the bill.... and those billing errors end up as incremental revenue for the provider.

 

[REWahoo]

But you know what I think that they do... I think that these "billing errors" are intentional because many people don't question them since they don't understand them or what they should legitimately need to pay for... they just say to themselves that it's only $5-10 and just pay the bill.... and those billing errors end up as incremental revenue for the provider.

That was my first thought, but then you have to realize what it costs to process that small bill. I doubt there is any real benefit to the provider once everything is taken into consideration.

 

[SumDay]

But you know what I think that they do... I think that these "billing errors" are intentional because many people don't question them since they don't understand them or what they should legitimately need to pay for... they just say to themselves that it's only $5-10 and just pay the bill.... and those billing errors end up as incremental revenue for the provider.

Exactly. Those bills may never be seen by a human eye. There's a balance, so the computer spits it out, it goes through the folder/stuffer and it's off to the USPS to either pi$$ someone off, or scare some unsuspecting soul into paying it because they don't know what an EOB is.

 

[jazz4cash]

That was my first thought, but then you have to realize what it costs to process that small bill. I doubt there is any real benefit to the provider once everything is taken into consideration.

You would think the processing cost would come into play but I’m sure it doesn’t. I go to chiropractor 2-3 times per week and EOBs for every visit come to me individually in a very nice business envelope 1st class mail. 4 sheets of heavy stock stationary but only 1 sheet is the EOB. The others are boilerplate in 15 languages and a sheet that only has our address.

I always wondered why they don’t have once a month billing statement like a credit card with each transaction being a line item. Imagine if visa sent you an individual statement for each and every purchase!

 

[aja8888]

I have a stack of EOB's from my insurer and Medicare sitting on my desk for my November 2019 hip replacement. I'm not going to look at them until I get a bill, which I should not, seeing I met my 2019 deductible of $185.00 in October 2019.

Maybe I'll get lucky and won't see an attempt to bill me since everything should have been covered by Medicare and my supplemental ins.

 

[JoeWras]

After an hour+ phone wait at insurance, and then quite a bit of research on her part, I got an answer as to why my prescription was strangely flagged on my refill attempt.

Turns out the pharmacy gave me too many pills on my first prescription (this was an accident). On refill, it showed that I wasn't ready for more because of this, however, the pharmacist shaved off a few pills on my refill, and it went through.

Basically, they are counting each and every 15 cent statin pill and putting restrictions on all this. Madness. I guess with all the checks they've had to put in place for opioids, they are using that computing power and putting them in place for everything. Less waste, I guess.

Anyway, my doctor gave me a differently written prescription and told me to skip insurance and use Good Rx. I did, and the cost was less than insurance, without the bureaucracy too.


I realize this isn't the same as the EOB issue, but there are analogs. This stuff will drive you crazy.