What's the difference between the bill from my insurance company and the one sent by my doctor. Am I being double billed??

What's the difference between the bill from my insurance company and the one sent by my doctor. Am I being double billed??
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#1

What’s the difference between the bill from my insurance company and the one sent by my doctor. Am I being double billed??


#2

You are not. 

Your insurance will bill you for the payment of your premium, which is the monthly cost of maintaining your policy active. 

Doctors and other medical practitioners bill you for their services, which includes their time, expertise and/use of their medical equipment and staff. 

When a bill is sent to your insurance carrier, it is processed and paid according to the terms of your policy. The doctor then sends you a statement for any amount that your insurance has calculated to be your liability. 

In turn, your insurance sends you an Explanation of Benefit (usually called EOB) detailing the charges, payment, contractual adjustment and your share of cost. These are NOT bills to you. They are merely a report for your files, and a way for you to verify that the owed amount on your doctor's statement matches the "patient liability" sum on the EOB. 

If they do, then you owe that amount. If they do not, contact your customer service and doctor's office for clarification.


#3

You are not being  double billed.  

The bill from your insurance company is either your insurance premium invoice, an Explanation of Benefits, EOB, or the amount you owe the medical provider.  Most often, the EOB from the health insurance carrier will indicate what you owe the medical provider, whether it is a portion of your deductible, copay or the provider was out-of-network and therefore you are responsible for the fees.   

An EOB is not a bill, it just informs you whether the medical provider was paid, how much was paid and if you still owe money to the provider.  Never feel that an EOB is a bill and I recommend always keeping it in your files.  

Once the medical bill arrives from the medical provider, compare it to the EOB, and make sure the figures match the charges on your bill.  

If you have any additional questions, please do not hesitate to call me at 845-238-2532.

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Adria Goldman Gross
CEO of MedWise Insurance Advocacy

#4

What you are receiving from the insurance company is an explanation of benefits on how they are going to pay the bill they received from your healthcare provider and what your liability will be.
You will want to match this explanation of benefits with the bill you receive from your health care provider. You will want to make sure what the provider says you owe matches what your insurance company says you owe.
Hope this helps!


#5

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