DID YOU KNOW YOU CAN APPEAL YOUR EXPLANATION OF BENEFITS?
Every time you visit a health care provider you receive an Explanation of Benefits (EOB) from your insurance provider. This is an important document that you should keep for your records. The EOB will show you the amount your health care provider billed for the visit, the amount your insurance company paid and the amount you could potentially owe. The EOB is not a bill. If you owe any money, you will receive a separate bill from your health care provider
Important things to look for on your EOB:
1. Customer Service Number: You can call your insurance provider if you have any questions.
2. Service Description: This shows what provider you went to and the date of service.
3. Provider Charges: This shows the amount your health care provider billed for your visit.
4. Paid By Insurer: This shows the amount your insurance provider paid for your visit.
5. What You Owe: This shows the amount you may be responsible for. You may have already paid a portion of this amount. If you paid a portion to your health care provider, that amount will not reflect on your EOB. Your EOB simply shows the amount your insurance provider will cover.
If you do not agree with the coverage or payment by your insurance company, you have the right to appeal. Look at your EOB to see how much time you have to appeal and what steps you need to take.
The Center for Medicare & Medicaid Services has a great sample EOB and further explains what each section means. Please visit their website for more information: https://www.cms.gov/files/document/11819-sample-explanation-benefits-508.pdf.
The Center for Elder Law & Justice is available to help. If you have received an Explanation of Benefits and have questions, concerns, or would like to appeal, please contact us at (716) 853-3087. In addition, our free legal advice helpline can provide answers to brief legal questions to residents of New York State who are 55 or older. Call at 1-844-481-0973 between 9am and 11am to reach an attorney directly or call and leave a message. The helpline can also be contacted via e-mail at helpline@elderjusiceny.org.
