Good Neighbor Insurance provides international travel medical insurance as well as Arizona medical insurance. Here are some things to consider when purchasing a U.S. domestic ACA (affordable care act) medical insurance plan.
Wrong Diagnosis or Procedure
You visit your PCP for a sore throat. When you receive your EOB you notice that instead of billing for a throat culture, yourr doctor’s office had mistakenly billed for a diabetes blood test. The computer program used by the doctor’s billing company automatically put down a diagnosis of diabetes, which you do not have.
Look Over every EOB and Medical Bill
First, make sure you receive an EOB after every visit to your doctor or another healthcare provider. Every time a provider submits a claim on your behalf, your insurance company must send you an EOB. Call your health plan if you do not get an EOB within six to eight weeks of a health-related service.
When you get your EOB: Check to make sure the dates and services you received are correct. If you find a mistake or you are not sure about a code, call your doctor’s office and ask the billing clerk to explain things you don’t understand.
Watch out for possible billing fraud or medical identity theft. If you did not receive the services or equipment listed on the EOB, contact your health plan immediately.
Read the remarks or code descriptions at the bottom or the back of your EOB. These remarks will explain why your health plan is not paying for a certain service or procedure, or paying less. Some common remarks are:
- out-of-network provider – you have used a provider who is not in your health plan’s network and the service may not be covered or may be subject to a coinsurance
- service is not a covered benefit – your insurance does not cover this service, such as a cosmetic procedure
- service is not medically necessary – your doctor has not documented that a service or procedure was necessary for your health or well-being
- invalid code – indicates that your healthcare provider made a coding error