Health Insurance Center

Health Insurance Q & As

Question 5 of 5 in Health Insurance Decisions For Singles
My insurance company doesn’t seem to ever pay what I think they are supposed to pay on my claims. My doctor just sends me a bill and I pay it. Help!
Here is how you handle a claim: First, an in-network doctor does the billing for you. Sometimes you pay part of a visit but you never pay the entire claim before you get the insurance company statement. Second, your carrier sends you an "Explanation of Benefits" or "EOB" (except in Medicare, where the same document is called an "Explanation of Medical Benefits" or "EOMB"). You read that document carefully and somewhere on it you will find the dollar amount you owe your physician or hospital. Third, you send a check to the physician/hospital/lab for whatever amount is in the "you owe this much" column. In-network doctors and hospitals are not allowed to "balance bill": pay what the carrier says you owe. If you continue to get a bill, fax or mail them a copy of the EOB with the amount highlighted that you owed and paid. That should be the end of the issue.