Does Your Doc Owe You Money? I’d Bet My Co-Pay On It…

How many of you actually know what your explanation of benefits are? Sounds boring, I know. Until recently, I never really knew myself, primarily because I didn’t bother to pay attention to them. If something came in the mail that said I was not responsible for any payments and/or it was covered by my benefits, that was all I needed to know.

Now that I am paying my own health insurance out-of-pocket (with some government aid thanks to Obama’s American Recovery and Reinvestment Act of 2009, which reduces the cost of COBRA for the unemployed), I look at everything related to my health bills a little more closely, including my EOBs.

It has come to my attention in recent months, that I sometimes pay a co-pay at a doctor’s office when I actually don’t need to. I’m usually only shelling out about $10 to $20 a visit, depending on the type of doctor I am seeing and I’m ok with that, because when I receive my EOB, it tells me if I actually needed to pay a co-pay or any other charges. The EOB is a complete breakdown of what my doctor charges for the visit, what my insurance company pays the doctor, what I am responsible for, and what costs were not covered, if any. It is, as it states, an explanation of your benefits.

As these annoying pieces of paper kept arriving in my mailbox, I started realizing that I was paying doctors when I didn’t need to. Since there were lots of lines and numbers and insurance jargon I didn’t quite understand, I called my carrier to make sure I was understanding this correctly.

What I heard on the other end shocked me. My doctor(s) receives these same EOBs. They see that I am indeed, not responsible for these co-pays and by law, are supposed to refund me my co-pay upon receipt of this document. Let me just tell you, checks are not miraculously showing up in my mail. Are they showing up in yours?

So I have to call my doctor(s) and explain which isn’t a big deal; well, most of the time. Sometimes they want a copy of the EOB (which I can easily obtain through my online account), sometimes they already have it on file. However, there are times when I get the run around for a measly $10. One doctor made me wait four months for a refund. I was told my doctor was too busy with patients to approve this. My insurance company finally called and just like that, the check was in the mail the next day. I’ve already been refunded nearly $100 in the last 2 months in overpaid co-pays! As I mentioned, it is against the law for physicians to not refund you your money (if you are owed money) when they receive this document, because they are receiving an overpayment; they have already been paid by your carrier. That is what you pay for by having benefits (whether you are like me and pay for them out-of-pocket or you are on a company plan).

I urge you to take a few minutes out of your hectic day to go over your explanation of benefits. While it may seem like only a few dollars, it all adds up in the end. If 4,000 people aren’t refunded their $10 co-pay, that’s $40,000 lost to working Americans. And we all could use an extra few buck in our pockets, couldn’t we?

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