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Health Care Reform:

Health Insurance & Affordable Care Act

Your Guide to Health Insurance Paperwork

Health insurance comes with a flood of paperwork, and much of it includes unfamiliar words and phrases. There are two main types of documents you'll receive. The first is called an explanation of benefits, or EOB. The second is medical bills. 

The guidelines below will help you understand the purpose of each and why they're important. That will help you spot billing mistakes, as well as help you learn how your insurance works and what charges you have to pay.

1. What is an EOB?

Your insurance company sends you an explanation of benefits when it gets a request for payment from one of your health care providers (such as doctors, specialists, laboratories, hospitals, and clinics). The EOB describes the medical treatment you got from the provider.

2. Why is an EOB important?

This statement is your chance to review the money that's being paid for your health care. By checking your EOB, you can track how much your health care costs. You also can look for billing errors. EOBs give you the chance to question any payment that doesn't look right.

3. What information is on an EOB?

It should show:

  • Your name and address
  • Your policy number
  • The name of the patient -- you or the person who got treatment
  • The name of the doctor who provided the care
  • The date of the service
  • The fee that you were charged for treatment
  • How much your insurance paid
  • How much you owe for this visit

Your EOB also should have a short description of the care the patient got. If part of the care was not covered by your insurance, the EOB will explain why.

4. What should you check on every EOB?

  • Whether you saw the doctor on the date listed
  • Whether you got the services the provider claims to have performed
  • Whether you are being billed more than once for the same service
  • How much the insurance company paid toward the total bill and whether that matches your plan's benefits
  • Whether you have to pay any or all of the bill because you haven't met your deductible
  • If the insurance company rejected any of the claim, and the reason why

5. What is a bill?

A bill is a request for payment from your health care provider. It will show how much you owe for your medical care after your insurance has paid its share.

6. What information is on a bill?

It should include:

  • The name and address of the medical provider
  • The date of the bill
  • Your name, address, and account number
  • The date of your treatment
  • The patient's name if it's not you
  • A description of the medical service that was given
  • How much you were charged
  • The amount your insurance paid for the service
  • The remaining amount that you owe
  • Other unpaid charges that you might have had before this bill

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