I keep getting bills from my doctor and don’t think my insurance company is paying what they should. What can I do?

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Asked March 25, 2013

1 Answer

There should not be any big surprises about what is or is not covered by your health insurance. Read your policy carefully and pay close attention to the exclusions and copays listed therein. If your insurance company is not paying all of the bills they are supposed to pay, contact the insurance carrier and request an explanation of the differences.

Most of the time, the doctor or care center that performs the treatment will also file the claim. You may be expected to pay a portion of the bill, called a copay, at the time the treatment is performed, but your portion of the bill should be paid long before the insurance company is billed at all.

Your insurance company should send you a statement called an Explanation Of Benefits, or EOB, which explains how the bill is to be paid. This statement will detail the bill, the portion of it that is paid by your insurer and the amount that you must pay yourself. This is the only amount you are required to pay. If the insurance policy does not pay the remainder of the bill, you will need to find out why they did not, and what you can do about it.

If you receive one or more bills after you have paid the portion shown as "balance due" from you, the next step is to contact your insurance company. Send them a copy of the bill, highlighting the portion marked as payable by you, along with the canceled check to show where you paid that amount. Include a note explaining that you have paid that amount, and requesting the company to pay the amount due from them. If you continue to receive bills after this has been done, you should first contact the insurance company for an explanation, and then contact your state's Department of Insurance to have the matter resolved. You can also speak with a local insurance agent who can see if they can find a better company for you.

Answered March 25, 2013 by Anonymous

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