Monday, November 22, 2010

More on EOB's

It really is a good idea to at least glance over your EOB's when they come in the mail, even if you're pretty sure you know what's coming.  For example I once caught a filing error on one of my kiddos trips to the pediatrician.  

The insurance I carry uses a different ID number for each person on the policy. While the first digits remain the same on each person the suffix changes (ie: 123456-01, 123456-02, 123456-03 etc).  When I had my youngest child they were automatically added to my policy with the next suffix in line even though their name wasn't on the insurance card yet.  

When I filled out paperwork at the pediatrician's office I noted that on the paperwork that this kiddo would be 123456-03 and I even told them when they copied the card.  Several months later I got an EOB for this office visit and I noticed that payment had been denied because the patient didn't fit the age requirements for the services billed.  The code that was billed was correct, a check up for an infant, however, despite my best efforts to notify the pediatrician's office of the insurance ID number they filed the office visit under my ID number and date of birth.  Since I'm clearly not an infant my insurance carrier denied payment and my EOB showed that I may owe my provider the full amount of about $180.  I called the billing office for the pediatrician's office to let them know about the error, so they could refile the claim with the correct ID and date of birth. Thankfully someone had already caught the mistake and refiled everything and had even received payment from my insurance carrier already.  

With the holiday's approaching I probably won't post anything for several days, but that doesn't mean you can't still email me questions! :)  

deargabbyinsurance@yahoo.com

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