How to Decipher Insurance Claims and Understand What You Owe | Ep. 20
Getting a statement from your insurance company can feel like trying to read a foreign language. What is an EOB? Why does it say, "This is not a bill?" And most importantly, what do you actually owe?
Melody Mulaik demystifies the Explanation of Benefits (EOB). She walks you through, step-by-step, how to find your EOBs on your insurer's website and how to read them line by line. You'll learn the difference between the "amount billed" and the "member rate," how to track your deductible, and what co-insurance really means for your wallet.
Stop guessing and feeling anxious about medical bills. This episode gives you the tools to confidently validate every bill you receive from a provider and ensure you're only paying what you truly owe.
Featured Topics:
- What an Explanation of Benefits (EOB) is and how to find it on your insurance company's website.
- Understanding the key terms on your EOB, like deductible, copay, and co-insurance.
- A line-by-line guide to reading your EOB, including the "amount billed," "member rate," and "your responsibility".
- How to find "remark codes" to understand why a claim might not have been paid and what your next steps should be.
What You’ll Hear:
- [00:00:00] Introduction: Why you must validate what you owe for a service.
- [00:01:00] How to find your "Explanation of Benefits" (EOB) on your insurer's website.
- [00:02:00] Understanding the EOB summary: "This is not a bill" and tracking your deductible.
- [00:03:00] Defining key terms: Co-insurance vs. Copay.
- [00:04:00] Breaking down the EOB columns: Service descriptions, CPT codes, and Amount Billed.
- [00:05:00] Finding your true cost: Understanding the "Member Rate," what's applied to your deductible, and your co-insurance.
- [00:06:00] A real-world example of how co-insurance is calculated.
- [00:07:00] What to do if a claim isn't paid: Finding and reading "remark codes".
- [00:08:00] How to use the EOB to validate any bill you receive from a provider.
Want to Ask Melody? Visit: https://melodymulaik.com/ASK Don’t forget to subscribe so you won’t miss an episode. If you've ever stared at a medical bill and an "Explanation of Benefits" (EOB) and had no idea if you actually owe that amount, this episode is a must-listen.
