The Newnan Times-Herald


Watch EOBs for mistakes, fraud

  • By The Newnan Times-Herald
  • |
  • Aug. 07, 2018 - 8:39 PM

Do you check your insurance EOB or just trash it, thinking that surely there would be no fraudulent activity or error on the part of the professionals?

When visiting any doctor’s office or medical facility, always get a printed receipt of the charges and your co-pay, if you have one. Save those until you get your Insurance EOB (explanation of benefits) and compare what services/products you received.

Since I became Medicare eligible, in the last 15 years I had only found one charge from a doctor for hospital visits. Impossible. I was not even in town on the dates for the charges. Bringing this to the attention to the clerk in the doctor’s office, it was found to be an honest mistake with one Social Security/Medicare number being transposed. This was corrected and the claim reversed.

This year alone, there have been two claims on my insurance for services/ products not received. One was in a doctor’s office. I took the paperwork to the clerk and an entry error was discovered and the claim corrected.

I am still in limbo over the second claim for a product that was dispensed on the same day that I left the facility with a splint for a broken wrist and a shoulder sling. There was also a charge for an arm brace that would fit a child. Both had the same date of service by the same PA on duty. There was also a co-pay for the sling and brace from the supplier, and I refused to co-pay for the brace and called the company, stating that I did not receive it and in no way would it fit me.

After threatening letters that this account would be turned over to a collection agency and attorney, I called again and stated that this was a fraudulent claim and I was notifying Medicare and they should take this claim to the service provider.

There have been no more threatening letters. I also brought this to the attention of the service provider and have been notified that this claim is being investigated as I stated my suspicions for this brace being tacked on to my account.

A head full of gray hair does not mean there is no activity underneath. Use that gray matter to protect yourself and your insurance.

Pat Craven