Tips from Paula: Understanding Balance Billing

As Employee Advocate here at Acadia Benefits, I spend a good deal of time helping our customers understand their bills from providers.  It is often confusing and hard to understand these statements.  The first thing we look for on a bill is some sort of reference to a payment or reduction from the insurance company.  This means that the bill has been correctly submitted to the insurance company. If there is no reference at all to this type of activity, there is a good chance that it was either submitted incorrectly (perhaps to an old policy) or not submitted at all.  If still not sure, we recommend that patients compare these statements to their insurance company’s Explanation of Benefits (EOBs) to see if the processing and payments line up.  If there is no record of a claim in the EOBs or in the online account, then the patient should call the provider to be sure the claim was actually submitted, and if not, to be sure they have updated ID card information so the claim can be sent ASAP. There is also a matter of “timely filing”, i.e., there are often time limits placed on how long a provider can wait before submitting a bill, so time is of the essence in these matters.

In addition, it is extremely important not to pay a bill unless you can confirm that you are not being billed beyond the applicable copay or contracted amount.  Contracted providers should not be billing the patient for the full charge of the visit.  Cross-referencing the EOBs can quickly show if the provider is billing you correctly.