Is My Insurance Carrier Adjudicating My Claims Correctly?
You’ve just received an explanation of benefits (EOB) from your insurance company and a bill from your doctor’s office. As you glance over the numbers, lingering thoughts nag in your mind: “Is everything being calculated correctly?” or “My explanation of benefits doesn’t match my bill, what do I do?” Understanding how to read both your EOB and bill is important to ensure your claim is correctly adjudicated.
What Does Adjudicated Mean?
Adjudication, in the realm of insurance, refers to the process where your claim goes through the carrier’s system. During this phase, various checks and calculations are made. This includes checking eligibility, assessing the services received against your policy’s benefits, and applying discounts or contractual rates. Once all these factors are considered, your claim is processed or adjudicated, and the outcome determines what you owe and what the insurance will cover.
Why is Adjudication Important?
If a claim is adjudicated inaccurately, it can lead to you paying more (or less) than you should. Mistakes, however small, can accumulate over time, leading to significant financial discrepancies. Correctly adjudicated claims protect your pocketbook and your peace of mind.
How Can I Check if My Claim has been Adjudicated Correctly?
It’s simpler than you might think:
Compare the Bills: One of the most straightforward methods is to compare your EOB from the insurance carrier with your doctor’s office bill. Do the numbers match? If they align, that’s a positive sign that the adjudication process has been accurate.
Review the Breakdown: Dive into the details. Ensure the services listed are the ones you received and the corresponding costs align with your expectations and policy provisions.
Ask Questions: If something doesn’t look right or you don’t understand a particular charge or discount, reach out! Both your doctor’s office and your insurance carrier are there to help clarify any uncertainties.
Trust, but verify. It’s always beneficial to be proactive about your financial health. By understanding the adjudication process and regularly checking the accuracy of your claims, you ensure that you’re paying (and being charged) the right amounts. And remember, a correctly adjudicated bill is not just about money—it’s about peace of mind. So, next time that bill lands in your mailbox, give it the attention it deserves and never question again why your explanation of benefits doesn’t match your bill again. Your wallet will thank you.
To learn more or to get expert assistance, contact us.