Let’s face it: your medical insurance explanation of benefits (EOB) is not a great read. Those letters with the funky codes and the big letters that say “THIS IS NOT A BILL” can be confusing or, at best, boring. It may be tempting to throw EOB statements in a file and deal with them later. But while they’ll never top the New York Times bestseller list, EOB’s are a must-read because they are your best defense against medical identity theft.
There are things you can do to help prevent medical identity theft, but identity thieves could still steal your personal information from a healthcare provider or insurer. If your medical identity is stolen, the sooner you can spot a problem, the better you can prevent your medical records and benefits from being damaged. To help ease the pain of reviewing your EOBs, here’s a cheat sheet about what to look for:
- Patient information: Check that the name, address, etc. are correct, whether the patient is you or another family member covered by your medical insurance.
- The healthcare provider and date the service was performed: Check that you recognize the doctor, hospital, or lab and confirm that you or the family member did have service that day.
- The amount the provider billed the plan: Make sure that this is in line with the services performed on that visit. One kind of medical fraud is to bill for more services than were provided, and clerical mistakes can also happen in billing. If the costs seem out of line, you can ask the provider for an itemized statement and challenge any errors.
- Breakdown of payment: The EOB will show the total cost of the service (the amount the plan approved), your plan’s share of the cost, and your share of the cost. If charges are refused, there will be a reason code explaining ineligible amounts or amounts paid, and there is usually a code key on the back of the statement.
Charges for services that didn’t happen, statements for a patient who doesn’t exist on your plan, or denial of coverage for legitimate services can be the first signs that someone has stolen your medical identity or that of a family member. Denial can mean that someone has run up charges that exceed your coverage limits. For example, if your plan has a limit on maternity benefits and an uninsured person had a baby using your coverage, you might see services denied. If you see a problem, call your insurer and provider and get to the bottom of it.
We know, reading EOB statements is a good way to put yourself to sleep, but it’s way better than losing sleep because of a bad case of medical identity theft.