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EOB is most important insurance document for patients


If you have health insurance, you should have a good idea how much a doctor's visit cost. Your co-pay is usually listed right on your ID card, but what if you, your doctor, and your insurer don't agree?

The key to getting the most out of any health insurance plan is to only use "in-network" providers and to understand the EOB - the Explanation of Benefits. When you use "in-network" providers, it doesn't matter how much they bill your insurance or how much they say you owe. The EOB from your insurance carrier is the only document you need to follow.

"I want to sleep at night, I don't want to worry about this $15 hanging over my head," Rose Stenberg said.

Stenberg's United Healthcare insurance card clearly shows she has a $15 co-pay whenever she visits her regular doctor at Banner Arizona Medical Clinic in Peoria.

"My doctor's office agrees, that's what they charge me, $15, then about a month later, whenever I get the bill, it's $30," Stenberg said.

It's not actually a bill. It's the United Healthcare Explanation of Benefits or EOB that says Stenberg owes $30 per visit. But the ID card shows $30 co-pays are only for specialists. Stenberg says her doctor isn't one.

"She's my primary doctor, I've been here 11 years and I must have had her as a doctor for nine of those years," Stenberg said.

All those years, Stenberg says she only owed the doctor $15 per visit. It's only been in the past few months the Explanation of Benefit statements started showing $30 owed. On top of that, a separate urgent care visit, which her policy also states has a $15 co-pay, showed a $30 co-pay too. When Stenberg didn't pay it, the small amount ended up in collections.

"I have an excellent credit rating, at least I did have until this, but it's going to take a hit I'm sure from this," Stenberg said.

Stenberg says she's asked United Healthcare to explain what's going on or fix the problem. If she doesn't get an answer soon, she's afraid more debt collectors will be calling.

"Even though I only got to the collection agency for the one, the other bills are outstanding," Stenberg said.

It's very important to make sure your EOB is accurate.

CBS 5 News contacted United Healthcare to see if there was some kind of glitch in their bookkeeping that was causing a $15 co-pay visit to a primary doctor, to look like a $30 co-pay visit to a specialist - and that is exactly what it turned out to be.

Stenberg said United Healthcare fixed the problem and issued a corrected EOB. That will essentially remove the outstanding balances from Stenberg's account and stop the collections process.

Remember, healthcare providers will always go with amounts that show up on the EOB; it is up to every patient to make sure this important document is correct.

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