An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. The EOB is commonly attached to a check or statement of electronic payment.
There are different plans such as a High–Deductible Health Plan With or Without a Health Savings Account. Similar to a catastrophic plan, you may be able to pay less for your insurance with a high–deductible health plan (HDHP). With an HDHP, you may have: One of these types of health plans: HMO, PPO, EPO, or POS. Your plan determines your coverage and monthly premium.
If you have questions about your plan you can contact your HR or benefits manager at the primary carrier’s place of employment. If you receive your insurance coverage through OMH, you would contact Amy Gordon or Traci Sachs.
This can be based on employers. To find out about your options and when your enrollment period is, contact your Corporate Benefits Manager or HR representative.
To learn more about Medicaid and CHIP (Healthcare for Children), or other government programs including Prescription Drug costs contact your local Job and Family Services, or we can also help you apply through our Resource Center.
Look at your insurance card – there should be a number under Member services to call for help to see what is covered or what providers are in network. You can call before you go to the doctor to make sure it will be covered.
You will want to do this prior to seeing any new doctor to make sure they are in network.
You are considered to be in the “donut hole” if you have not met your deductible yet. You have to do this before your insurance will cover you. To find out what your deductible is refer to your EOB.
What are my options? Can I get outside help?
Make sure they have your insurance information on file! Contact your provider at the number on your billing statement to see if they offer a financial assistance program.
Charity care programs help uninsured patients who can’t afford to pay their medical bills and don’t qualify for government aid. The patient services department of the hospital can help you find out if you are eligible.
If you are not eligible, there are outside agencies that can help in every community. There are many programs out there such as RxHope, and also financial and support services for Cancer Patients. Contact our Resource Center for help, or you can also call your local United Way to see what agencies are available in your area. 2-1-1 is a community resource navigation service that can also help direct you to local charities. Most communities have a local Job and Family Services, community action commission, Salvation Army, St. Vincent DePaul Society, United Way, cancer association, and Council on Aging, to name just a few. Agency programs and eligibility guidelines and funding can vary.
Some providers will expect your co-pay upfront at the time of your visit. You can ask them if they can bill this amount to you, or if you can speak to a financial billing counselor.
Visit the provider’s financial assistance page on their website or call their billing office to learn more about discounts available to patients, programs that may waive fees or offer sliding fee scales, as well as the ability to create a payment plan. Financial assistance is available through many providers. You can usually find this information on your billing statement.
Some visits also have charges for ancillary departments (e.g., Radiology, Pathology, Anesthesia, etc.); please check to see if your bill includes an ancillary charge. During a hospital stay, you may have a charge from the attending physician even if that is not your PCP.
Some hospitals offer a sliding fee scale or a program to waive your fees. For instance, Cleveland Clinic offers a 6-18 month interest free payment plan or financial assistance if you are at or below a percentage of the Federal Poverty Guidelines (FPG). If you do not have insurance you may also receive free or discounted care depending on your income and what you qualify for based on their eligibility guidelines.
Most providers will offer to set up a payment plan, at the minimum. You need to call the billing office to ask about your options. You should be able to find a contact number on the statement.
Once it goes into collections the provider may direct you to call them directly by giving you another number to call the third party billing or collections office HOWEVER you may still be able to arrange payment plans or even dispute the charge and have it waived or put on HOLD until it is rectified.
If you can, it is beneficial to create a Health Savings Plan. This will help with expenses until you have met your deductible or your patient liability even after you’ve met your deductible.
A lot of providers now use medical billing services. You may get a bill from someone other than your doctor’s office. Stand alone clinics can cost less than the hospital. If you’re using dollars from your Health Savings Account – it pays to shop around.
If you have questions about your benefits call the number on your insurance ID card. If you have questions about your bill, contact the provider. You can find their contact information on the billing statement. Always make sure they have your updated insurance information. Sometimes, it’s as easy as giving your insurance ID number to them so that they can resubmit the claim.
Under the Emergency Medical Treatment and Labor Act (EMTALA), you’re guaranteed access to an emergency medical evaluation, even if you can’t pay. The act requires hospitals that received Medicare funding and that provide emergency services to evaluate anyone who comes to their emergency room and requests treatment. If the evaluation confirms that you have an emergency medical condition, including active labor, they are then required to provide stabilizing treatment for you regardless of your ability to pay (usa.gov).
If you would like further information or help, please feel free to contact our resource center at 877-881-1623.