Services: Health Insurance

If they don’t already, consumers would be wise to review their explanation of benefits (EOB) statements the next time they incur medical-related charges that are paid through their health insurance.

According to a recent nationwide poll of Angie’s List members, 30 percent say their health insurance company denied claims that should have been paid based on their plan coverage.

Another 30 percent say they have found mistakes in the way their insurance company processed their claims, with the most common complaints being errors in coding and the denial of covered services.

“It’s critical to understand your health insurance coverage, because too many people pay their medical bills without questioning them and they may be paying more than they actually owe,” says Angie Hicks, founder of Angie’s List (www.angieslist.com), the nation’s leading provider of consumer ratings on health care providers, including health insurance companies and billing services.

“Closely monitor your health care bills and keep a watchful eye out for duplicate charges, charges for services not rendered and other mistakes. Also, always review your EOB statements to ensure your insurer is covering – and not denying payment – for services covered by your plan. Some of our members said they had simple coding errors on their EOB that took months and sometimes years to resolve.”

Some companies still send EOB statements by mail, but others rely on an online system to view your EOB.  If so, be sure that your carrier or your employer provides you with the correct access information to view your statements online.

According to the Angie’s List poll, more than half of the respondents said they had only a partial understanding or no understanding at all of what is covered under their policy.

“Purchasing health insurance is just as important as purchasing a house,” Hicks adds. “Most policies are complicated and too few of us take the time to really read through them and understand how the coverage works. Don’t be afraid to ask questions to make sure you understand what your health plan does and does not cover.”

Billing is such a complicated matter that it’s created a new industry of professionals who audit bills for consumers. They generally work on a contingency basis, so their payment depends on them finding problems with your billing and is a percentage of any money they are able to save you. Those with large or frequent health care bills might be well-served to consider such services. Angie’s List recently added a billing services category to its offerings and encourages members to help others find good professionals by submitting reports on billing agents they’ve hired.

Angie’s List offers 8 tips to help consumers navigate through their medical bills:

• Read through your health insurance plan to be sure you understand the coverage before you use it.
• Review your plan annually or anytime your health-care related situation changes.
• Pay special attention to how you must select a primary care provider, co-payment requirements and access to emergency care. You are responsible for following the plan’s process. If you don’t, you may have to pay more out-of-pocket than you expect.
• Keep track of all payments you make. If you need to pay by cash, get receipts and file them all in one place.
• Never sign blank insurance forms or give blanket authorization to a health care provider to bill for services rendered.
• Always review the list of services your doctor performs at the time of your visit, the list of services you are billed for and your EOB statements after that bill is paid. Be on the lookout for duplicate charges, charges for services not rendered, services denied that might be covered by your insurer or other mistakes. Contact your insurer as soon as possible with any questions you have.
• Don’t be afraid to ask your health care provider’s office staff to help you work through issues. They often have good relationships with insurance companies and help resolve issues.
• Always document any communication with your insurer and health care providers. Note the names of people you spoke with; dates, times and locations of those conversations and the context of that communication.

*1,362 Angie’s List members took the poll. Responses are representative of Angie’s List members but not the general public.

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Angie’s List collects consumer reviews on local contractors and doctors in more than 500 service categories. Currently, more than 1 million consumers across the U.S. rely on Angie’s List to help them make the best hiring decisions. Members get unlimited access to local ratings via Internet or phone, exclusive discounts, the Angie’s List magazine and help from the Angie’s List complaint resolution service. Take a quick tour of Angie’s List and view the latest Angie’s List news releases.