UNDERSTANDING MEDICAL INSURANCE EOBS

When I first started my practice, I came in blind about the whole insurance game. I had no idea what a deductible, co-insurance, co-pay or benefits were. In fact, I learned how to do everything by calling Anthem and fortunately they were kind enough to go over a bill with me. After many headaches I finally figured out this insurance game and in this article I am going to walk you through what is called an EOB (Explanation Of Benefits) and give you some pointers on how to be prepared in knowing what your insurance covers and what they don’t before you go to the doctor.

In my office, I make a copy of your card and call the insurance company to find out what is covered and what you have to pay (benefits) before you get treated. This way you can get the best deal.

Before you go to the doctor, you will want to call the number on the back of your insurance card and ask for what is called, “Benefits.” They will ask you for what service, tell them you want benefits for all health related services, including chiropractic and physical therapy. After you write them down, make sure you carry them with you or put them in a safe place. When you go to the doctor, before you get treated, have them call in and check the benefits for you again and compare what you were told earlier to what they tell you. Sometimes the insurance people will tell you different things than what they tell your doctor. This way you will know if your visit will or will not be covered and when you get your statement, you will be prepared ahead of time knowing exactly what you will have to pay. You will also want to try and make sure that whomever you are going to see is “in the network”. I accept all insurance here and am “in the network” with almost all of them.

When you call, they will tell you that you might have a deductible and some other things that you might not fully understand. So, I am going to explain some of the terminology to you.
First of all, you might have a deductible. This is the amount you have to pay before the insurance takes effect. Next you might have co-pay. This is what you pay on every visit. This is nice because if the bill gets high you won’t have to pay any more than the co-pay. Next, you might have to pay co-insurance. This is a percentage of the bill that you have to pay. It usually ranges from 80/20 to 50/50 whereas you pay 20% and your insurance pays 80%. You might also have an out-of-pocket limit. This means that after you match that limit from paying your deductible/co-pay/co-insurance, then the insurance will pick up 100% afterwards and you will not have to pay anything.

After you go to the doctor and the doctor turns the claim in, about a month later you will get what is called an EOB (explained above). This explains what the insurance company paid your provider and what you may owe to your provider. Make sure you look at this closely and compare what you might have already paid your doctor at the time of your visit to what is on the EOB. This is important because you might have met your out-of-pocket before you paid your doctor. This means that you didn’t have to pay anything and your provider may owe you money. If you or anyone has any questions about this, feel free to give me a call or go ahead and bring your statement in and I will look at it for FREE!!! I am also going to do a seminar soon with examples to help explain this more in detail. Look for the dates, times, and locations of the seminar in future articles.

I also wanted to let you know that we have a new promotion here at Nill Family Chiropractic and Wellness Center. From March 1st to May 1st, for any new patient who comes in for a treatment, a FREE 15-minute massage will be given. So come on in, even if you are in pain or not, and take advantage of this opportunity. Remember that chiropractic is good for not only treating pain but preventing it as well. Studies show that chiropractic can help the immune system and prevent other diseases like arthritis. We accept all insurance and if you’re a cash patient who doesn’t have insurance, or their insurance doesn’t cover chiropractic, call and ask how you can get 25% off of your bill.

Until next time, I am Dr. James P. Nill DC.

Take care and have a healthy day.

 

If you or anyone you know has any questions or would like to know more of what I can do for you, then give me a call to set up your free initial consultation. Again, please contact me by phone at 260-459-2205 or by e-mail at drnill@nillfamilychiropractic.com.

If you have any questions or if you want to come in for the free consultation, the address is: Nill Family Chiropractic and Wellness Center at 4656 W. Jefferson Blvd., Suite 240, Fort Wayne, IN 46804.

Also, feel free to check out our website to see all that we have to offer at www.nillfamilychiropractic.com.

The Waynedale News Staff

James P. Nill, D.C.

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