Common medical billing errors and how to check for them, using the six steps CMS publishes, plus who to ask for a correction once you find one.
A summary statement is not the claim. How to request an itemized hospital bill, what a CPT code is, and how the line items line up with your EOB.
An EOB is not a bill. Here is how to read an explanation of benefits column by column, using the field definitions CMS publishes for consumers.
Provider directories are not always accurate. Here is how to verify a doctor is in network for your specific plan, using the checks CMS itself lists.
An EOB is your health plan’s statement of what a claim did, not a request for money. Here is how it differs from the provider’s bill, and which one arrives first.
The trade is not premium against deductible. It is a certain monthly cost against an uncertain one, and the number it turns on is the out-of-pocket maximum.
In network the allowed amount is a price both sides agreed to. Out of network it is a number only your plan set, and the provider never signed it.
The letters commit a plan to two things: whether it pays anything out of network, and whether it requires referrals. Everything else is a tendency.
Deductible, copays and coinsurance on covered care count. Premiums, non-covered services and balance-billed amounts do not. And it is rarely one counter.
Deductible, coinsurance and out-of-pocket maximum run in a fixed order, and all of it is calculated on the allowed amount, not on the bill.