After you visit your doctor, your doctor's office submits a bill (also called a claim) to your insurance company. A claim lists the services your doctor provided to you. The insurance company uses the information in the claim to pay your doctor for those services.
When the insurance company pays your doctor, it will send you a report called an Explanation of Benefits, or EOB, that shows you what it did. You need to be able to read and understand the EOB to know what your insurance company is paying for, what it's not paying for, and why. An EOB is not a bill.
Your doctor's office might send you a statement. A statement will show you how much you owe the doctor. If you receive a statement before your insurance company pays your doctor, do not need pay the amounts listed at that time. After your insurance company pays your doctor, you will need to pay the doctor any balance due.
Here are some things to look for:
• If the dates of service and description of services on your EOB and billing statement aren't the same, or if they don't match other records you may have of the visit, contact your doctor's office first.
• If you have questions about why the insurance company did not cover something or about the amount you have to pay, contact the insurance company.
• If more than 60 days have passed and the insurance company still hasn't paid your doctor, contact the insurance company.
Finally, keep your EOBs and statements organized (e.g., filed by date) so that you can access them easily should questions arise. When payments are made, note the date and amount paid on the EOB and statement.