What’s the deal with those “This is Not a Bill” statements?

Schoolhouse Rock Bill

Do you get mysterious mail from your health insurance company? Does it look a lot like a bill from a doctors’ office, but then says, “This is not a bill” at the top? Congratulations, you’ve received an Explanation of Benefits (EOB). And you’re going to get them all the time. Want to know what they are? Read on!

  • Why do I keep getting these in the mail? If it’s not a bill, what is it?

Every time you use your health insurance benefits, your insurance company will send you a statement that shows the service you had (like an office visit) and how they applied your benefits to it. If office visits are covered at 80% after a copay, then the statement is showing how much of the office visit was covered by your health insurance.

Most insurance companies put the words, “This is not a bill” on the EOB because these look remarkably similar to the bill you get from your doctor’s office. You want to make sure you only pay the doctor’s bill – don’t pay the insurance company.

  • I don’t want these. Can I get them stopped?

Actually, health insurance companies are required by law to send them to you, although you may be able to get them by email instead of regular mail.

 EOB’s don’t necessarily make for exciting reading, but it’s a really good idea to open them and glance to make sure they are correct. You know best what doctor you saw, on what date and what service you had.  If you see something wrong on your EOB, you’ll want to call your health insurance company and get it clarified because chances are good that the bill you’ll get from the doctor will also be incorrect.

 (I once got an EOB showing a visit to a doctor I’d never heard of. I ignored it. Later I got a bill from that same doctor, which I also ignored. Next, I got a call from a collections agency! I spent the next two weeks dodging calls from “Vinnie” and checking under my car before I got in. Looking back, I probably should have called my insurance company right away…)

  • This thing is so confusing! In one place it says my responsibility is $0.00. But then in the “Amount Not Covered” section it says $85.00 isn’t covered. So which is it?

You’ll see a lot of dollar amounts on an EOB, and it can be hard to find the one you really care about. Mainly you want to look for the amount that says “Patient Responsibility” or “Amount you Owe.”

If you saw an in-network (PPO) doctor, then your doctor agreed to be paid a fixed amount, regardless of what they would normally charge. On the EOB you would see the amount the doctor usually charges (probably called the “Charged Amount” or “Billed Amount”) and then you’ll also see the fixed amount that the doctor agreed to accept (probably called the “Allowed Amount” or “Contracted Amount”). The difference between those two might be called the “Write Off,” “Disallowed,” or “Amount Not Covered.” The great news? You don’t have to pay that amount!

An example:

Charged       Allowed        Not Covered     Plan Paid    Patient Responsibility   
$185             $100              $85                       $100            $0

If you saw an out of network doctor, then you aren’t protected by an Allowed Amount, and any difference between what your insurance company pays and the amount the doctor charges will be passed on to you. Your EOB might look like this:

Charged       Allowed        Not Covered     Plan Paid    Patient Responsibility   
$185             $100              $85                       $100            $85.00

  • I’ve been throwing these EOB’s away because I didn’t need them. But now our Flex Spending Account company is saying that I need them to prove some of my expenses. Is there any way I can get a new copy?

That shouldn’t be a problem. Your health insurance company can usually provide you with another copy of your EOB(s). Most large insurers have an online resource where you can log in and download them yourself. (Remember, there are privacy laws that may prevent you from downloading the EOB’s for your spouse or children over age 16. They might have to do it for themselves.)

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2 Comments

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  2. Crowguys

     /  September 14, 2012

    Ironic that something with “explanation” in the name needs further… explanation. LOL! This was helpful. And I’m really glad PacificSource sends EOBs via email, now. I no longer have to login to InTouch to get a copy. (But it’s nice to know they’re in InTouch, incase I delete my EOB email by accident.)

    Reply

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